Provider Demographics
NPI:1306960786
Name:GREENWALD, DOUGLAS K (DDS,MS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3168 TURNER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5756
Mailing Address - Country:US
Mailing Address - Phone:530-622-0874
Mailing Address - Fax:530-622-0874
Practice Address - Street 1:3168 TURNER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5756
Practice Address - Country:US
Practice Address - Phone:530-622-0874
Practice Address - Fax:530-622-0874
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics