Provider Demographics
NPI:1558855619
Name:GREENHILL FAMILY DENTAL CARE LLC
Entity Type:Organization
Organization Name:GREENHILL FAMILY DENTAL CARE LLC
Other - Org Name:GREENHILL FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-753-2252
Mailing Address - Street 1:14535 JOHN MARSHALL HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4025
Mailing Address - Country:US
Mailing Address - Phone:703-753-2252
Mailing Address - Fax:703-753-2268
Practice Address - Street 1:14535 JOHN MARSHALL HWY STE 209
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4025
Practice Address - Country:US
Practice Address - Phone:703-753-2252
Practice Address - Fax:703-753-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410917261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental