Keith R. Gronbach, D.D.S., Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

44317 Issued in CA

Legal business name

KEITH R. GRONBACH, D.D.S., INC.

Practice address

3799 Mt Diablo Blvd
Lafayette, CA 94549-3538

Phone

(925) 283-4050

Fax

(925) 283-5340

NPI assigned

Oct 2, 2006

Last updated

Jul 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keith R. Gronbach, D.D.S.NPI 1992853204

Title

President

Phone

(925) 283-4050

Specialties & licenses 1

Addresses

Other names 1

• East Bay Oral Surgery Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keith Roger Gronbach, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Lafayette, CA
  • NPI 1992853204
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1093808594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3799 MT DIABLO BLVD",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945493538",
            "telephone_number": "925-283-4050",
            "fax_number": "925-283-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3799 MT DIABLO BLVD",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945493538",
            "telephone_number": "925-283-4050",
            "fax_number": "925-283-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH R. GRONBACH, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "GRONBACH",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-283-4050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "44317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bay Oral Surgery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Eliza Kern, AMFT
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• Oral and Maxillofacial Surgery (Dentist) in Lafayette, CA
• Providers in Lafayette, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.