Provider Demographics
NPI:1316104938
Name:GREENSPON, FRED D (DDS0602)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:D
Last Name:GREENSPON
Suffix:
Gender:M
Credentials:DDS0602
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 19TH ST NW
Mailing Address - Street 2:#604
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:#604
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:202-223-0767
Practice Address - Fax:202-293-8897
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC2381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist