Provider Demographics
NPI:1508930306
Name:GREENBAUM, LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
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 1:5480 WISCONSIN AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-652-6011
Mailing Address - Fax:301-656-7433
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:4708 BRADLEY BLVD T2
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-652-6011
Practice Address - Fax:301-656-7433
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD46861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4686OtherMARYLAND DENTAL LICENSE
MD4686OtherMARYLAND DENTAL LICENSE