Individual
DR. LARA MIRIAM GREENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
7487 S STATE ROAD 121, MACCLENNY, FL 32063-5451
(904) 259-6211
(904) 259-7129
Mailing address
7487 S STATE ROAD 121, MACCLENNY, FL 32063-5451
(904) 259-6211
(904) 259-7129
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15057
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076942800
—
FL
Enumeration date
02/21/2008
Last updated
06/09/2016
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