# CENTER GROVE DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Center Grove Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881152585
- **Authorized official:** DR. SUNG H KONG DDS (OWNER)
- **Authorized official phone:** (317) 882-7800

## Contact information

- **Practice address:** 4800 W SMITH VALLEY RD STE K, GREENWOOD, IN 46142-9195
- **Practice address phone:** (317) 882-7800
- **Practice address fax:** (317) 893-2986
- **Mailing address:** 4800 W SMITH VALLEY RD STE K, GREENWOOD, IN 46142-9195
- **Mailing address phone:** (317) 882-7800
- **Mailing address fax:** (317) 893-2986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/12/2019
- **Last updated:** 03/12/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200533220 | — | IN |