Provider Demographics
NPI:1205990728
Name:GREENBERG, EMILY RADNER (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:RADNER
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N MAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5819
Mailing Address - Country:US
Mailing Address - Phone:859-221-1707
Mailing Address - Fax:
Practice Address - Street 1:2859 S PULASKI RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4456
Practice Address - Country:US
Practice Address - Phone:773-522-0855
Practice Address - Fax:773-522-7440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice