| Center Grove Dental, Llc | |
|
4800 W Smith Valley Rd Ste K Greenwood IN 46142-9195 | |
| (317) 882-7800 | |
| (317) 893-2986 |
| Full Name | Center Grove Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 4800 W Smith Valley Rd Ste K, Greenwood, Indiana |
| Authorized Official Name and Position | Sung H Kong (OWNER) |
| Authorized Official Contact | 3178827800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Grove Dental, Llc 4800 W Smith Valley Rd Ste K Greenwood IN 46142-9195 Ph: (317) 882-7800 | Center Grove Dental, Llc 4800 W Smith Valley Rd Ste K Greenwood IN 46142-9195 Ph: (317) 882-7800 |
| NPI Number | 1881152585 |
|---|---|
| Provider Enumeration Date | 03/12/2019 |
| Last Update Date | 03/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881152585 | NPI | - | NPPES |
| 200533220 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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