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NPI Code Detail

MEDICARE: DR. KENNETH GREENBERG D.M.D.

MEDICARE: DR. KENNETH GREENBERG D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry10816MA

General Provider Information

NPI Number : 1053327908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH GREENBERG D.M.D.
Provider Business Mailing Address
First Line : 1234 HYDE PARK AVE
Second Line : SUITE 103
City : HYDE PARK
State : MA
Zip : 02136-2819
Country : US
Telephone Number : 617-361-6996
Fax Number :
Provider Business Practice Location Address
First Line : 1234 HYDE PARK AVE
Second Line : SUITE 103
City : HYDE PARK
State : MA
Zip : 02136-2819
Country : US
Telephone Number : 617-361-6996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/08/2007

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