Healthcare Provider Details

I. General information

NPI: 1639278484
Provider Name (Legal Business Name): DANA SUE GREENWALD D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW SUITE 604
WASHINGTON DC
20015-2014
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW SUITE 604
WASHINGTON DC
20015-2014
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-0045
  • Fax: 202-364-1386
Mailing address:
  • Phone: 202-966-0045
  • Fax: 202-364-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5260
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10371
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: