Provider Demographics
NPI:1497283915
Name:GREENBAUM, NOAM MOSHE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOAM
Middle Name:MOSHE
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 1:5715 CORTEEN PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1622
Mailing Address - Country:US
Mailing Address - Phone:248-514-2097
Mailing Address - Fax:
Practice Address - Street 1:16133 VENTURA BLVD STE 470
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2402
Practice Address - Country:US
Practice Address - Phone:248-514-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-28
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022269122300000X
CA1076081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentist