Provider Demographics
NPI:1841228285
Name:GREENSPAN, DEBORAH (DSC)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:GREENSPAN
Suffix:
Gender:F
Credentials:DSC
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:SCRIVEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DSC
Mailing Address - Street 1:1635 DIVISADERO STREET
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:513 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2205
Practice Address - Country:US
Practice Address - Phone:415-476-2045
Practice Address - Fax:415-514-2862
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00SP2110Medicaid
CAU99867Medicare UPIN
CA00SP2110Medicare PIN