Provider Demographics
NPI:1407076532
Name:GREENSPAN, RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
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 1:3810 VALLEY CENTRE DR
Mailing Address - Street 2:902A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3308
Mailing Address - Country:US
Mailing Address - Phone:858-755-8882
Mailing Address - Fax:858-755-8806
Practice Address - Street 1:3810 VALLEY CENTRE DR
Practice Address - Street 2:902A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3308
Practice Address - Country:US
Practice Address - Phone:858-755-8882
Practice Address - Fax:858-755-8806
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA957264Medicare UPIN