Provider Demographics
NPI:1821322561
Name:GREENBERGER, ALYSSA MARLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARLIN
Last Name:GREENBERGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:STE. A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5211
Mailing Address - Country:US
Mailing Address - Phone:727-522-5554
Mailing Address - Fax:727-527-7233
Practice Address - Street 1:7601 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:STE. A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5211
Practice Address - Country:US
Practice Address - Phone:727-522-5554
Practice Address - Fax:727-527-7233
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist