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General NPI Number Information
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NPI Number | 1902889900
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Entity Type | Individual
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Provider Name | KENNETH ROBERT GREENBAUM DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2450 LANCASTER DR NE SUITE 200
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City | SALEM
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State | OR
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Zip | 97305-1130
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Country | US
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Telephone | 503-362-9548
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Fax | 503-362-2189
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Provider Business Mailing Address
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Address Line | 34 NORTHVIEW CT
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-1072
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Country | US
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Telephone | 503-699-7758
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Fax | 503-699-1194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4701
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License Number State | OR
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