Provider Demographics
NPI:1811041098
Name:GREENAGEL, JOSEPH DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:GREENAGEL
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 1:106 E WASHINGTON AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2823
Mailing Address - Country:US
Mailing Address - Phone:218-793-2297
Mailing Address - Fax:218-739-4142
Practice Address - Street 1:106 E WASHINGTON AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2823
Practice Address - Country:US
Practice Address - Phone:218-793-2297
Practice Address - Fax:218-739-4142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice