=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326919812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KPG, OMS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 293 MAIN AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-471-0099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 293 MAIN AVE
-----------------------------------------------------
City | PASSAIC
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07055-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KARLA PEREZ-GOLDBERG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 973-471-0099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------