Provider Demographics
NPI:1356644512
Name:GREENWAY DENTAL GROUP
Entity Type:Organization
Organization Name:GREENWAY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-345-2880
Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:102
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-345-2880
Mailing Address - Fax:301-345-6287
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:102
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-345-2880
Practice Address - Fax:301-345-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13883122300000X
MD63171223P0221X
MD126531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty