Healthcare Provider Details

I. General information

NPI: 1730241142
Provider Name (Legal Business Name): JOSEPH GREENBAUM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42301 CHERRY HILL RD SUITE D
CANTON MI
48188-9801
US

IV. Provider business mailing address

22610 KENWYCK DR
SOUTHFIELD MI
48034-4762
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-4040
  • Fax: 734-981-2683
Mailing address:
  • Phone: 734-981-4040
  • Fax: 734-981-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: