Provider Demographics
NPI:1720246200
Name:GREENVILLE DENTAL CENTER
Entity Type:Organization
Organization Name:GREENVILLE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-825-1551
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-0185
Mailing Address - Country:US
Mailing Address - Phone:270-338-2532
Mailing Address - Fax:270-641-0237
Practice Address - Street 1:132 E MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1576
Practice Address - Country:US
Practice Address - Phone:270-338-2535
Practice Address - Fax:270-641-0237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISLAND FORD FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-30
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty