MEDICARE: DARREN SCOTT GREENWELL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7709	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295719078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN SCOTT GREENWELL DMD

Provider Business Mailing Address
First Line	:	6234C NORTH PRESTON HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229
Country	:	US
Telephone Number	:	502-955-6134
Fax Number	:	502-955-6135

Provider Business Practice Location Address
First Line	:	6234C NORTH PRESTON HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-4487
Country	:	US
Telephone Number	:	502-955-6134
Fax Number	:	502-955-6135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	02/08/2013

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