Provider Demographics
NPI:1629002324
Name:GREENWALD, ARTHUR M (DDS)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:M
Last Name:GREENWALD
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 1:80 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3958
Mailing Address - Country:US
Mailing Address - Phone:732-548-1220
Mailing Address - Fax:732-548-2132
Practice Address - Street 1:80 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3958
Practice Address - Country:US
Practice Address - Phone:732-548-1220
Practice Address - Fax:732-548-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008768001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU05270Medicare UPIN