Provider Demographics
NPI:1467665463
Name:GREENBERG, MARSHALL S (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:S
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1138
Mailing Address - Country:US
Mailing Address - Phone:203-735-9600
Mailing Address - Fax:203-954-0014
Practice Address - Street 1:201 DIVISION ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1138
Practice Address - Country:US
Practice Address - Phone:203-735-9600
Practice Address - Fax:203-954-0014
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2056992Medicaid