Healthcare Provider Details

I. General information

NPI: 1366687402
Provider Name (Legal Business Name): ADA LUCIA GREENFIELD D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N BETHLEHEM PIKE SUITE S - 100
LOWER GWYNEDD PA
19002-1427
US

IV. Provider business mailing address

1600 N BETHLEHEM PIKE SUITE S - 100
LOWER GWYNEDD PA
19002-1427
US

V. Phone/Fax

Practice location:
  • Phone: 215-654-5380
  • Fax: 215-654-5382
Mailing address:
  • Phone: 215-654-5380
  • Fax: 215-654-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS 035746
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: