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General NPI Number Information
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NPI Number | 1952471880
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Entity Type | Individual
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Provider Name | JONATHAN GREENBURG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 10/31/2017
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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 | 818-205-1122
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Fax | 818-386-8963
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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 | 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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