Provider Demographics
NPI:1538488176
Name:KENNETH M. GREENBERG DDS & NANCY E. FREIBAUM DDS PA
Entity Type:Organization
Organization Name:KENNETH M. GREENBERG DDS & NANCY E. FREIBAUM DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-920-6608
Mailing Address - Street 1:8529 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3288
Mailing Address - Country:US
Mailing Address - Phone:813-920-6608
Mailing Address - Fax:813-920-8816
Practice Address - Street 1:8529 GUNN HWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3288
Practice Address - Country:US
Practice Address - Phone:813-920-6608
Practice Address - Fax:813-920-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN100561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty