=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295948826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS GREENWALD RIGER KYSER & WANG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10045 BALTIMORE NATIONAL PIKE SUITE A1
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-418-8370
-----------------------------------------------------
Fax | 410-418-9068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10045 BALTIMORE NATIONAL PIKE SUITE A1
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-418-8370
-----------------------------------------------------
Fax | 410-418-9068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. RONALD GREENWALD
-----------------------------------------------------
Credential | DDS PA
-----------------------------------------------------
Telephone | 410-418-8370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 6125
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------