Provider Demographics
NPI:1831255579
Name:GREENSTEIN, JEFFREY HOWARD (DDS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:GREENSTEIN
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 1:8651 FORT SMALLWOOD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-437-3773
Mailing Address - Fax:410-437-5302
Practice Address - Street 1:8651 FORT SMALLWOOD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-437-3773
Practice Address - Fax:410-437-5302
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD64101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
191086OtherUNITED CONCORDIA
MDD636OtherCARE FIRST
T77266Medicare UPIN
MDR388Medicare ID - Type Unspecified