Provider Demographics
NPI:1790292431
Name:GREENMAN, ALIX
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:GREENMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 CRESCENT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-9401
Mailing Address - Country:US
Mailing Address - Phone:303-917-7775
Mailing Address - Fax:
Practice Address - Street 1:6179 S BALSAM WAY STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3092
Practice Address - Country:US
Practice Address - Phone:303-933-8282
Practice Address - Fax:303-948-5610
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000082581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty