Provider Demographics
NPI:1023217254
Name:GREENFIELD, GLENN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1202
Mailing Address - Country:US
Mailing Address - Phone:818-361-1213
Mailing Address - Fax:818-361-1912
Practice Address - Street 1:11550 INDIAN HILLS RD STE 220
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1202
Practice Address - Country:US
Practice Address - Phone:818-361-1213
Practice Address - Fax:818-361-1912
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice