Provider Demographics
NPI:1417699646
Name:GREENBURG DENTAL GROUP, PC.
Entity Type:Organization
Organization Name:GREENBURG DENTAL GROUP, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-578-3500
Mailing Address - Street 1:4418 VINELAND AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2159
Mailing Address - Country:US
Mailing Address - Phone:818-578-3500
Mailing Address - Fax:818-796-3322
Practice Address - Street 1:4418 VINELAND AVE STE 112
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2159
Practice Address - Country:US
Practice Address - Phone:818-578-3500
Practice Address - Fax:818-796-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty