Provider Demographics
NPI:1093115065
Name:FIORENZA DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:FIORENZA DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIORENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-886-7803
Mailing Address - Street 1:438 S EMERSON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1948
Mailing Address - Country:US
Mailing Address - Phone:317-886-7803
Mailing Address - Fax:
Practice Address - Street 1:438 S EMERSON AVE STE 230
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1948
Practice Address - Country:US
Practice Address - Phone:317-886-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012160A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty