Provider Demographics
NPI:1619047487
Name:GREENSTEIN, BRUCE ION (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ION
Last Name:GREENSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:ION
Other - Last Name:GREENSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:162 ADAMS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5239
Mailing Address - Country:US
Mailing Address - Phone:303-333-4209
Mailing Address - Fax:303-333-0095
Practice Address - Street 1:162 ADAMS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5239
Practice Address - Country:US
Practice Address - Phone:303-333-4209
Practice Address - Fax:303-333-0095
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1051901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1075859OtherTAX ID