Provider Demographics
NPI:1306066956
Name:JONATHAN GREENBURG, DDS, INC
Entity type:Organization
Organization Name:JONATHAN GREENBURG, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GIL
Authorized Official - Last Name:GREENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-205-1122
Mailing Address - Street 1:24981 PALMILLA DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3053
Mailing Address - Country:US
Mailing Address - Phone:818-205-1122
Mailing Address - Fax:818-386-8963
Practice Address - Street 1:5400 BALBOA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5200
Practice Address - Country:US
Practice Address - Phone:818-205-1122
Practice Address - Fax:818-386-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30452332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5834630001Medicare NSC
CA6116160001Medicare NSC