=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053642181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN C. GREENMAN, D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2010
-----------------------------------------------------
Last Update Date | 07/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 S WESTLAKE BLVD SUITE 223
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-496-9555
-----------------------------------------------------
Fax | 805-497-2541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3056 THREE SPRINGS DR SUITE 223
-----------------------------------------------------
City | WESTLAKE VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-5581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-496-9555
-----------------------------------------------------
Fax | 805-497-2541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. STEVEN C. GREENMAN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 805-496-9555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 29903
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------