Provider Demographics
NPI:1871630764
Name:GREENBERG, MITCHELL (DMD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11966 80TH RD
Mailing Address - Street 2:APT A1
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1169
Mailing Address - Country:US
Mailing Address - Phone:718-544-8888
Mailing Address - Fax:718-793-6315
Practice Address - Street 1:11966 80TH RD
Practice Address - Street 2:APT A1
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1169
Practice Address - Country:US
Practice Address - Phone:718-544-8888
Practice Address - Fax:718-793-6315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0385631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics