# BRANDYWINE DENTAL GROUP, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215995279
- **Authorized official:** DR. BRIAN L. KIRKWOOD D.D.S (OWNER)
- **Authorized official phone:** (317) 462-3456

## Contact information

- **Practice address:** 101 N STATE ST, GREENFIELD, IN 46140-2177
- **Practice address phone:** (317) 462-3456
- **Practice address fax:** (317) 462-3465
- **Mailing address:** 101 N STATE ST, GREENFIELD, IN 46140-2177
- **Mailing address phone:** (317) 462-3456
- **Mailing address fax:** (317) 462-3465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1209025 | IN | Yes |

## Other

- **Enumeration date:** 05/01/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000000104288 | BC/BS PIN | IN |