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General NPI Number Information
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NPI Number | 1629580576
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Entity Type | Organization
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Legal Business Name | GREENBURG, DDS, PC
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD STE 120
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City | ENCINO
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State | CA
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Zip | 91316-5200
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Country | US
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Telephone | 818-205-1122
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Fax | 818-386-8963
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Provider Business Mailing Address
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Address Line | 24981 PALMILLA DR
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City | CALABASAS
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State | CA
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Zip | 91302-3053
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Country | US
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Telephone | 818-414-4817
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Fax | 818-591-1510
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN GIL GREENBURG
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Credential | D.D.S.
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Telephone | 818-205-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 30452
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30452
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License Number State | CA
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