Provider Demographics
NPI:1932626447
Name:GREENBURG, MARK A (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GREENBURG
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 1:2672 11TH AVE # 80631
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8016
Mailing Address - Country:US
Mailing Address - Phone:970-616-0262
Mailing Address - Fax:
Practice Address - Street 1:2672 11TH AVE # 80631
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8016
Practice Address - Country:US
Practice Address - Phone:970-616-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2048281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics