Provider Demographics
NPI:1023067931
Name:GINSBURG, MICHAEL STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:GINSBURG
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 1:1930 GREENWOOD DR
Mailing Address - Street 2:APT A
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2430
Mailing Address - Country:US
Mailing Address - Phone:573-785-5678
Mailing Address - Fax:
Practice Address - Street 1:1930 GREENWOOD DR
Practice Address - Street 2:APT A
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2430
Practice Address - Country:US
Practice Address - Phone:573-785-5678
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040037851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice