Provider Demographics
NPI:1740383330
Name:GREENBERG, GARY SCOTT (DMD FAGD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DMD FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SOUTH WARREN ST
Mailing Address - Street 2:STE 1700
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-422-1788
Mailing Address - Fax:315-422-1788
Practice Address - Street 1:109 SOUTH WARREN ST
Practice Address - Street 2:STE 1700
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-422-1788
Practice Address - Fax:315-422-1788
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS033643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist