Healthcare Provider Details

I. General information

NPI: 1629103486
Provider Name (Legal Business Name): MICHAEL M. GREENWALD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NORTH MAIN ST. EXTENSION BUILDING 2, SUITE 1-D
WALLINGFORD CT
06492-4214
US

IV. Provider business mailing address

850 NORTH MAIN ST. EXTENSION BUILDING 2, SUITE 1-D
WALLINGFORD CT
06492-4214
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3005
  • Fax:
Mailing address:
  • Phone: 203-265-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number041599
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCT 7481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: