Provider Demographics
NPI:1083758445
Name:GREENBERG, MYA POPE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYA
Middle Name:POPE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-1556
Mailing Address - Country:US
Mailing Address - Phone:229-377-6125
Mailing Address - Fax:
Practice Address - Street 1:240 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-1556
Practice Address - Country:US
Practice Address - Phone:229-377-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice