MEDICARE: GREENWOOD FAMILY DENTISTRY, P.C.

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	1223G0001X	General Practice Dentistry	019025104	IL

General Provider Information

NPI Number	:	1841595212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD FAMILY DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	3500 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3300
Country	:	US
Telephone Number	:	773-238-1717
Fax Number	:	773-779-1656

Provider Business Practice Location Address
First Line	:	3500 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3300
Country	:	US
Telephone Number	:	773-238-1717
Fax Number	:	773-779-1656

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARFIELD BATCHELOR
Credential	:
Telephone Number	:	773-238-1717

Provider Enumeration Date	:	01/17/2011
Last Update Date	:	01/17/2011

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