Healthcare Provider Details

I. General information

NPI: 1417699646
Provider Name (Legal Business Name): GREENBURG DENTAL GROUP, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 VINELAND AVE STE 112
TOLUCA LAKE CA
91602-2159
US

IV. Provider business mailing address

4418 VINELAND AVE STE 112
TOLUCA LAKE CA
91602-2159
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-3500
  • Fax: 818-796-3322
Mailing address:
  • Phone: 818-578-3500
  • Fax: 818-796-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LIZ DUENAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-578-3500