Healthcare Provider Details

I. General information

NPI: 1710210596
Provider Name (Legal Business Name): TERRY W GREENSTEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S PINE ST
NEWTON KS
67114-3765
US

IV. Provider business mailing address

215 S PINE ST
NEWTON KS
67114-3765
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-6103
  • Fax: 316-283-1333
Mailing address:
  • Phone: 316-283-6103
  • Fax: 316-283-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6648
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: