Provider Demographics
NPI:1821494386
Name:KENNETH D. GREENSTADT D.D.S., INC.
Entity Type:Organization
Organization Name:KENNETH D. GREENSTADT D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:GREENSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-792-6262
Mailing Address - Street 1:3565 TORRANCE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4847
Mailing Address - Country:US
Mailing Address - Phone:310-792-6262
Mailing Address - Fax:
Practice Address - Street 1:3565 TORRANCE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4847
Practice Address - Country:US
Practice Address - Phone:310-792-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243001223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty