Healthcare Provider Details

I. General information

NPI: 1225331143
Provider Name (Legal Business Name): GREENWOOD DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N 1100 E SUITE D
AMERICAN FORK UT
84003-2054
US

IV. Provider business mailing address

226 N 1100 E SUITE D
AMERICAN FORK UT
84003-2054
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-6037
  • Fax: 801-756-6088
Mailing address:
  • Phone: 801-756-6037
  • Fax: 801-756-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number136489
License Number StateUT

VIII. Authorized Official

Name: DR. DALE MAX GREENWOOD
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 801-756-6037