Provider Demographics
NPI:1184837171
Name:GREENSPAN, MELVIN A (DDS,)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:A
Last Name:GREENSPAN
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 1:500 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6948
Mailing Address - Country:US
Mailing Address - Phone:310-937-6460
Mailing Address - Fax:
Practice Address - Street 1:500 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6948
Practice Address - Country:US
Practice Address - Phone:310-937-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics