# OLIVE BRANCH DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Olive Branch Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053904409
- **Authorized official:** DR. SRINIVAS DURSHANAPALLI DDS (MANAGING PARTNER)
- **Authorized official phone:** (217) 303-5955

## Contact information

- **Practice address:** 2826 S STATE ROAD 135 STE C, GREENWOOD, IN 46143-9603
- **Practice address phone:** (317) 743-7777
- **Practice address fax:** (317) 854-6577
- **Mailing address:** 2826 S STATE ROAD 135 STE C, GREENWOOD, IN 46143-9603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/17/2021
- **Last updated:** 03/03/2021