Provider Demographics
NPI:1720475569
Name:GREENWALD, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOODCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6382
Mailing Address - Country:US
Mailing Address - Phone:410-653-7454
Mailing Address - Fax:
Practice Address - Street 1:1134 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3931
Practice Address - Country:US
Practice Address - Phone:410-744-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics