Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS017822L | PA |
NPI | 1013121037 |
---|---|
Provider Name | Dr. Joseph R Greenberg |
First Address | Villanova, PA 19085-1135 |
Second Address | Villanova, PA 19085-1135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 20/12/2016 |