Provider Demographics
NPI:1235562836
Name:GREENSPAN, AMY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:GREENSPAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:DULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668
Mailing Address - Country:US
Mailing Address - Phone:816-560-0141
Mailing Address - Fax:
Practice Address - Street 1:303 SPRING ST.
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:MO
Practice Address - Zip Code:65668-0125
Practice Address - Country:US
Practice Address - Phone:816-560-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist