Provider Demographics
NPI:1679590459
Name:GOLDBERGER, HEATHER ADRIANNE (DDS, MBA)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ADRIANNE
Last Name:GOLDBERGER
Suffix:
Gender:F
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8918 SHORE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5506
Mailing Address - Country:US
Mailing Address - Phone:347-492-0073
Mailing Address - Fax:
Practice Address - Street 1:32 COURT ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4404
Practice Address - Country:US
Practice Address - Phone:718-625-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice