Provider Demographics
NPI:1790797306
Name:GREENSPAN, DOUGLAS L (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:GREENSPAN
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 1:213 FREDERICK AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877
Mailing Address - Country:US
Mailing Address - Phone:301-948-5858
Mailing Address - Fax:301-926-8566
Practice Address - Street 1:213 FREDERICK AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:301-948-5858
Practice Address - Fax:301-926-8566
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist