Provider Demographics
NPI:1336537786
Name:ANTHONY J GREENWOOD, DDS, LLC
Entity type:Organization
Organization Name:ANTHONY J GREENWOOD, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-856-2173
Mailing Address - Street 1:1440 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BAXTER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66713-2727
Mailing Address - Country:US
Mailing Address - Phone:620-856-2173
Mailing Address - Fax:620-856-2414
Practice Address - Street 1:1440 PARK AVE
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-2727
Practice Address - Country:US
Practice Address - Phone:620-856-2173
Practice Address - Fax:620-856-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5590261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental