Provider Demographics
NPI:1689301095
Name:GREENWOOD DENTAL ARTS
Entity type:Organization
Organization Name:GREENWOOD DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-740-9353
Mailing Address - Street 1:8490 E CRESCENT PKWY STE 370
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2853
Mailing Address - Country:US
Mailing Address - Phone:303-740-9353
Mailing Address - Fax:
Practice Address - Street 1:8490 E CRESCENT PKWY STE 370
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2853
Practice Address - Country:US
Practice Address - Phone:303-740-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNO OTHER IDENTIFIERS