Kenneth M Goldberg, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

59459 Issued in CA

Practice address

201 N College Drive
Suite 202
Santa Maria, CA 93454

Phone

(805) 928-7611

Fax

(805) 349-8551

NPI assigned

Oct 6, 2005

Last updated

Jul 30, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pitrowski and Goldberg Dental Group

  dba Coastal Oral Surgery and Dental Implant Center

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Santa Maria, CA
  • NPI 1255100046
  NPD

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1326036120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N COLLEGE DRIVE",
            "address_2": "SUITE 202",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "93454",
            "telephone_number": "805-928-7611",
            "fax_number": "805-349-8551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N COLLEGE DRIVE",
            "address_2": "SUITE 202",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "93454",
            "telephone_number": "805-928-7611",
            "fax_number": "805-349-8551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "KENNETH",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "59459",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI018568",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7056508",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thor C Gjerdrum, MD
• Chotinan Glass, PT
• Cassidy Glasser, PA-S
• Jennifer M Goeddel, MD
• Elaine Goggin, MSW
• Tracie Goldsmith
• Andrew Scott Goldstein, MD
• Anaiz Gomez Dominguez
• Jordan Arnold Gomez-Padilla
• Stephanie Gomez-Rubalcava

• Oral and Maxillofacial Surgery (Dentist) in Santa Maria, CA
• Providers in Santa Maria, 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 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.