Provider Demographics
NPI:1902574312
Name:GREENWOOD DENTAL CARE
Entity Type:Organization
Organization Name:GREENWOOD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-753-9673
Mailing Address - Street 1:626 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3707
Mailing Address - Country:US
Mailing Address - Phone:317-753-9673
Mailing Address - Fax:
Practice Address - Street 1:2801 FAIRVIEW PL STE U
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1339
Practice Address - Country:US
Practice Address - Phone:317-881-1680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty