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General NPI Number Information
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NPI Number | 1487937793
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Entity Type | Organization
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Legal Business Name | GREENBAUM & KOBREN D.D.S, P.L.L.C
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 14 MAPLE ST SUITE 101
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2967
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Country | US
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Telephone | 516-767-2484
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Fax | 516-767-1672
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Provider Business Mailing Address
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Address Line | 14 MAPLE ST SUITE 101
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2967
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Country | US
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Telephone | 516-767-2484
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Fax | 516-767-1672
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL GREENBAUM
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Credential | D.D.S
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Telephone | 516-767-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 048262
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License Number State | NY
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