Provider Demographics
NPI:1629218961
Name:GREENBERG, JORDAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:A
Last Name:GREENBERG
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 1:500 E MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2937
Mailing Address - Country:US
Mailing Address - Phone:914-355-0840
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2937
Practice Address - Country:US
Practice Address - Phone:914-355-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107221223S0112X
NY0556021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055602OtherNYS LICENSE
CT010722OtherCT LICENSE