MEDICARE: DR. MICHAEL M GREENBURG 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
1	1223G0001X	General Practice Dentistry	DO4947	FL

General Provider Information

NPI Number	:	1972545051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL M GREENBURG D.M.D.

Provider Business Mailing Address
First Line	:	6820 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2818
Country	:	US
Telephone Number	:	904-733-3110
Fax Number	:	904-733-8520

Provider Business Practice Location Address
First Line	:	6820 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2818
Country	:	US
Telephone Number	:	904-733-3110
Fax Number	:	904-733-8520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/05/2021

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