Provider Demographics
NPI:1396811592
Name:GREENBERG, BEN STANLEY (DDS)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:STANLEY
Last Name:GREENBERG
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 1:114 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1310
Mailing Address - Country:US
Mailing Address - Phone:291-487-3361
Mailing Address - Fax:201-487-6163
Practice Address - Street 1:114 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1310
Practice Address - Country:US
Practice Address - Phone:201-487-3361
Practice Address - Fax:201-487-6163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008789001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice