Keith Roger Gronbach, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

44317 Issued in CA

Practice address

3799 Mt Diablo Blvd
Lafayette, CA 94549-3538

Phone

(925) 283-4050

Fax

(925) 283-5340

NPI assigned

Jan 5, 2007

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

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 Oct 18, 2017 through Oct 18, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1992853204",
    "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": {
        "last_name": "GRONBACH",
        "first_name": "KEITH",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "44317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Gonzalez
• Whitney Goodenow
• Danyel Albert Goto
• Alissa Greenberg, PHD, BCBA-D
• Gary Michael Groch, PHD
• Brandi Grover
• Kassandra Jennifer Gudino
• Alison Guida
• Gurinder K Randhawa MD Inc
• Kathy V Gusenkov

• 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.
• 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.