Marc R Greenbaum DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

15147 Issued in OH

Legal business name

MARC R GREENBAUM DDS INC

Practice address

18611 Detroit Ave
Lakewood, OH 44107

Phone

(216) 221-2210

Fax

(216) 226-8037

NPI assigned

Jun 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marc R Greenbaum, DDS

Title

President

Phone

(216) 221-2210

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811939564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18611 DETROIT AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "44107",
            "telephone_number": "216-221-2210",
            "fax_number": "216-226-8037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18611 DETROIT AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "44107",
            "telephone_number": "216-221-2210",
            "fax_number": "216-226-8037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARC R GREENBAUM DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENBAUM",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-221-2210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "15147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0455449",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.