Provider Demographics
NPI:1366687402
Name:GREENFIELD, ADA LUCIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:LUCIA
Last Name:GREENFIELD
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 1:1600 N BETHLEHEM PIKE
Mailing Address - Street 2:SUITE S - 100
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1427
Mailing Address - Country:US
Mailing Address - Phone:215-654-5380
Mailing Address - Fax:215-654-5382
Practice Address - Street 1:1600 N BETHLEHEM PIKE
Practice Address - Street 2:SUITE S - 100
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-1427
Practice Address - Country:US
Practice Address - Phone:215-654-5380
Practice Address - Fax:215-654-5382
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0357461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics