Healthcare Provider Details

I. General information

NPI: 1861324881
Provider Name (Legal Business Name): MARK H GOLDENBERG DDS A DENTAL CORP DARRIN J HIRT DDS MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 BEACON BLVD
WEST SACRAMENTO CA
95691-3462
US

IV. Provider business mailing address

414 N CAMDEN DR STE 675
BEVERLY HILLS CA
90210-4518
US

V. Phone/Fax

Practice location:
  • Phone: 916-702-1213
  • Fax:
Mailing address:
  • Phone: 310-271-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AYREN ENGELHARDT
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 530-919-8661