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Organization
CENTER GROVE DENTAL, LLC
Active
Organization
CENTER GROVE DENTAL, LLC
Active
Other names
Center Grove Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUNG H KONG DDS (OWNER)
(317) 882-7800
Entity
Organization
Contact information
Practice address
4800 W SMITH VALLEY RD STE K, GREENWOOD, IN 46142-9195
(317) 882-7800
(317) 893-2986
Mailing address
4800 W SMITH VALLEY RD STE K, GREENWOOD, IN 46142-9195
(317) 882-7800
(317) 893-2986
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200533220
—
IN
Enumeration date
03/12/2019
Last updated
03/12/2019
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