Provider Demographics
NPI:1366609190
Name:GREENFIELD, ELISHA JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ELISHA
Middle Name:JAMES
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504-06 EAST 87TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6525
Mailing Address - Country:US
Mailing Address - Phone:773-374-2737
Mailing Address - Fax:773-374-4266
Practice Address - Street 1:1504-06 EAST 87TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6525
Practice Address - Country:US
Practice Address - Phone:773-374-2737
Practice Address - Fax:773-374-4266
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2156241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics