Provider Demographics
NPI:1043326879
Name:GOLDBERG, LISA (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3532
Mailing Address - Country:US
Mailing Address - Phone:248-608-2626
Mailing Address - Fax:248-608-8149
Practice Address - Street 1:1814 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3532
Practice Address - Country:US
Practice Address - Phone:248-608-2626
Practice Address - Fax:248-608-8149
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry