Provider Demographics
NPI:1265560346
Name:GREENBAUM, BERNARD LAWRENCE (DDS)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:LAWRENCE
Last Name:GREENBAUM
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 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:#106
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-530-3600
Mailing Address - Fax:301-564-1199
Practice Address - Street 1:6410 ROCKLEDGE DRIVE
Practice Address - Street 2:#106
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-530-3600
Practice Address - Fax:301-564-1199
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD77481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6362480001Medicare NSC