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General NPI Number Information
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NPI Number | 1336537786
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Entity Type | Organization
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Legal Business Name | ANTHONY J GREENWOOD, DDS, LLC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 1440 PARK AVE
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City | BAXTER SPRINGS
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State | KS
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Zip | 66713-2727
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Country | US
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Telephone | 620-856-2173
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Fax | 620-856-2414
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Provider Business Mailing Address
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Address Line | 1440 PARK AVE
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City | BAXTER SPRINGS
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State | KS
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Zip | 66713-2727
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Country | US
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Telephone | 620-856-2173
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Fax | 620-856-2414
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | ANTHONY J GREENWOOD
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Credential | DDS
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Telephone | 620-856-2173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5590
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License Number State | KS
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