Provider Demographics
NPI:1225331143
Name:GREENWOOD DENTAL
Entity Type:Organization
Organization Name:GREENWOOD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-756-6037
Mailing Address - Street 1:226 N 1100 E
Mailing Address - Street 2:SUITE D
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2054
Mailing Address - Country:US
Mailing Address - Phone:801-756-6037
Mailing Address - Fax:801-756-6088
Practice Address - Street 1:226 N 1100 E
Practice Address - Street 2:SUITE D
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2054
Practice Address - Country:US
Practice Address - Phone:801-756-6037
Practice Address - Fax:801-756-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1364891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty