Provider Demographics
NPI:1457552622
Name:GREENBERG, DAVID ISAAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ISAAC
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 WINKLER RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8125
Mailing Address - Country:US
Mailing Address - Phone:239-481-6433
Mailing Address - Fax:239-481-6455
Practice Address - Street 1:6120 WINKLER RD
Practice Address - Street 2:SUITE I
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8125
Practice Address - Country:US
Practice Address - Phone:239-481-6433
Practice Address - Fax:239-481-6455
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist