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General NPI Number Information
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NPI Number | 1972545051
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Entity Type | Individual
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Provider Name | MICHAEL M GREENBURG D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 6820 SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2818
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Country | US
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Telephone | 904-733-3110
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Fax | 904-733-8520
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Provider Business Mailing Address
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Address Line | 6820 SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2818
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Country | US
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Telephone | 904-733-3110
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Fax | 904-733-8520
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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 | DO4947
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License Number State | FL
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