Provider Demographics
NPI:1568073096
Name:FDG MOBILE
Entity Type:Organization
Organization Name:FDG MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-300-7403
Mailing Address - Street 1:438 S EMERSON AVE STE 231
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:317-300-7403
Mailing Address - Fax:317-851-9085
Practice Address - Street 1:438 S EMERSON AVE STE 231
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:317-300-7403
Practice Address - Fax:317-851-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental