Provider Demographics
NPI:1386858488
Name:GREENBAUM, MICHAEL LANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LANCE
Last Name:GREENBAUM
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 1:162 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5910
Mailing Address - Country:US
Mailing Address - Phone:516-932-8313
Mailing Address - Fax:
Practice Address - Street 1:488 GREAT NECK RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4308
Practice Address - Country:US
Practice Address - Phone:516-466-5222
Practice Address - Fax:516-466-5525
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0486231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice