Provider Demographics
NPI:1033123229
Name:GREENBAUM, STEVEN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WASHINGTON VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7176
Mailing Address - Country:US
Mailing Address - Phone:732-563-0066
Mailing Address - Fax:
Practice Address - Street 1:161 WASHINGTON VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7176
Practice Address - Country:US
Practice Address - Phone:732-563-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ97051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice