Individual
MR. KENNETH M GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
201 N COLLEGE DRIVE, SUITE 202, SANTA MARIA, CA 93454
(805) 928-7611
(805) 349-8551
Mailing address
201 N COLLEGE DRIVE, SUITE 202, SANTA MARIA, CA 93454
(805) 928-7611
(805) 349-8551
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
59459
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DI018568
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7056508
—
NJ
Enumeration date
10/06/2005
Last updated
07/30/2021
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