Provider Demographics
NPI:1649422163
Name:GREENBERG, ROY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:L
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 1:8525 SW 92ND ST
Mailing Address - Street 2:A-3B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-595-1556
Mailing Address - Fax:305-270-9449
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:A-3B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-595-1556
Practice Address - Fax:305-270-9449
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13225122300000X
FL3473122300000X
FL11046122300000X
FL75021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist