Provider Demographics
NPI:1891925434
Name:GREENBERG, ANDREW WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
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 1:3 GAMECOCK AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3378
Mailing Address - Country:US
Mailing Address - Phone:843-556-4798
Mailing Address - Fax:
Practice Address - Street 1:3 GAMECOCK AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3378
Practice Address - Country:US
Practice Address - Phone:843-556-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice