# AMP DENTAL SOUTH, LLC

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

## Provider details

- **NPI number:** 1275389223
- **Authorized official:** MICHELLE JACOMINO-BARNES (DIR. CREDENTIALING AND ENROLLMENT)
- **Authorized official phone:** (315) 454-6000

## Contact information

- **Practice address:** 331 S STATE ROAD 135 STE D, GREENWOOD, IN 46142-1453
- **Practice address phone:** (317) 859-0600
- **Mailing address:** PO BOX 70887, CLEVELAND, OH 44190-0887
- **Mailing address phone:** (315) 354-6000

## Taxonomy

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

## Other

- **Enumeration date:** 04/29/2024
- **Last updated:** 04/29/2024