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

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- **Entity:** Organization
- **Status:** Active
- **Other names:** East Bay Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093808594
- **Authorized official:** DR. KEITH R. GRONBACH D.D.S. (PRESIDENT)
- **Authorized official phone:** (925) 283-4050

## Contact information

- **Practice address:** 3799 MT DIABLO BLVD, LAFAYETTE, CA 94549-3538
- **Practice address phone:** (925) 283-4050
- **Practice address fax:** (925) 283-5340
- **Mailing address:** 3799 MT DIABLO BLVD, LAFAYETTE, CA 94549-3538
- **Mailing address phone:** (925) 283-4050
- **Mailing address fax:** (925) 283-5340

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 44317 | CA | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 07/22/2020