Glen Goleburn, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

G10000965 Issued in DE

Practice address

1290 Peoples Plaza
Newark, DE 19702

Phone

(302) 836-3750

Fax

(302) 836-2693

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 21, 2015 through May 21, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1801980396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 PEOPLES PLAZA",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "19702",
            "telephone_number": "302-836-3750",
            "fax_number": "302-836-2693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 PEOPLES PLAZA",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "19702",
            "telephone_number": "302-836-3750",
            "fax_number": "302-836-2693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLEBURN",
        "first_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "G10000965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001030708",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001030831",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Goldshteyn, MS
• Gregg H Goldstein, MD
• Howard B Goldstein, DO
• Jennifer N. Goldstein, MD
• Stefanie E Golebiewski-Manchin, M.D.
• Amanda Golshiri
• Cindy Elida Gomes Garcia, PA-C
• Awildry Gomez
• Barry Lee Gommer Jr., L.AC.
• Mary C Gonzales, DO

• General Practice Dentistry in Newark, DE
• Providers in Newark, DE by specialty
• General Practice Dentistry in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.