Provider Demographics
NPI:1275073256
Name:INDIJU3DENTAL LLC
Entity Type:Organization
Organization Name:INDIJU3DENTAL LLC
Other - Org Name:GREEN HILL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-991-8750
Mailing Address - Street 1:2121 MORGANTOWN RD.
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607
Mailing Address - Country:US
Mailing Address - Phone:717-991-8750
Mailing Address - Fax:717-865-1492
Practice Address - Street 1:2121 MORGANTOWN RD.
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607
Practice Address - Country:US
Practice Address - Phone:717-991-8750
Practice Address - Fax:717-865-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029748-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty