Provider Demographics
NPI:1548869704
Name:GOLOMBECK, CHAVIVA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAVIVA
Middle Name:
Last Name:GOLOMBECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 ELRAY DR APT D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2934
Mailing Address - Country:US
Mailing Address - Phone:917-494-8634
Mailing Address - Fax:
Practice Address - Street 1:2730 HANOVER PIKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1914
Practice Address - Country:US
Practice Address - Phone:410-374-4882
Practice Address - Fax:410-374-0702
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1952525438OtherDENTAL