# FDG MOBILE

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

## Provider details

- **NPI number:** 1568073096
- **Authorized official:** DR. GARRETT FIORENZA DDS (CEO)
- **Authorized official phone:** (317) 300-7403

## Contact information

- **Practice address:** 438 S EMERSON AVE STE 231, GREENWOOD, IN 46143-1948
- **Practice address phone:** (317) 300-7403
- **Practice address fax:** (317) 851-9085
- **Mailing address:** 438 S EMERSON AVE STE 231, GREENWOOD, IN 46143-1948
- **Mailing address phone:** (317) 300-7403
- **Mailing address fax:** (317) 851-9085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/10/2020
- **Last updated:** 08/10/2020