Provider Demographics
NPI:1962679746
Name:ROBERT O GREENWALD DDS PC
Entity Type:Organization
Organization Name:ROBERT O GREENWALD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-358-7566
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:#20 W JOHNSON
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628
Mailing Address - Country:US
Mailing Address - Phone:573-358-7566
Mailing Address - Fax:573-358-1736
Practice Address - Street 1:#20 W JOHNSON
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628
Practice Address - Country:US
Practice Address - Phone:573-358-7566
Practice Address - Fax:573-358-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty