Chaviva Golombeck, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17106 Issued in MD

Practice address

2730 Hanover Pike
Manchester, MD 21102-1914

Phone

(410) 374-4882

Fax

(410) 374-0702

NPI assigned

Oct 20, 2020

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Premier Dental Care

  • General Practice Dentistry
  • Manchester, MD
  • NPI 1386001006
  NPD (past)

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1548869704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6416 ELRAY DR APT D",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092934",
            "telephone_number": "917-494-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 HANOVER PIKE",
            "city": "MANCHESTER",
            "state": "MD",
            "postal_code": "211021914",
            "telephone_number": "410-374-4882",
            "fax_number": "410-374-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLOMBECK",
        "first_name": "CHAVIVA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-20",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "17106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL",
            "identifier": "1952525438",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "crisp",
            "affiliation": "Y",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2730 Hanover Pike",
            "city": "Manchester",
            "state": "MD",
            "country_code": "US",
            "postal_code": "211021914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nikolaus Euwer
• Stephen Freeman, MPT, ATC
• Allison Jean Gidusko, MS
• John Robert Gleespen, PHARMD
• Glow Aesthetics & Hormone LLC
• James Erdman Hall
• Helaina Ebling Counseling, L.L.C.
• Bobbie Leann Humphrey, CD(DONA)
• Jacqueline G. Hancock, Crna, PA
• Joamfro Health LLC

• General Practice Dentistry in Manchester, MD
• Providers in Manchester, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.