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Organization
AMP DENTAL SOUTH, LLC
Active
Organization
AMP DENTAL SOUTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO-BARNES (DIR. CREDENTIALING AND ENROLLMENT)
(315) 454-6000
Entity
Organization
Contact information
Practice address
331 S STATE ROAD 135 STE D, GREENWOOD, IN 46142-1453
(317) 859-0600
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
(315) 354-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/29/2024
Last updated
04/29/2024
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