Provider Demographics
NPI:1952471880
Name:GREENBURG, JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GREENBURG
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 1:24981 PALMILLA DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3053
Mailing Address - Country:US
Mailing Address - Phone:818-205-1122
Mailing Address - Fax:818-386-8963
Practice Address - Street 1:5400 BALBOA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5200
Practice Address - Country:US
Practice Address - Phone:818-205-1122
Practice Address - Fax:818-386-8963
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice