Provider Demographics
NPI:1922670819
Name:GREENWICH DENTAL LLC
Entity Type:Organization
Organization Name:GREENWICH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-622-3068
Mailing Address - Street 1:100 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6257
Mailing Address - Country:US
Mailing Address - Phone:203-622-3068
Mailing Address - Fax:203-622-3069
Practice Address - Street 1:100 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6257
Practice Address - Country:US
Practice Address - Phone:203-622-3068
Practice Address - Fax:203-622-3069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENWICH DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty