# OLIVE BRANCH DENTAL-2 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Olive Branch Dental Columbus
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972264398
- **Authorized official:** DR. SRINIVAS DURSHANAPALI DDS (PRESIDENT)
- **Authorized official phone:** (217) 303-5955

## Contact information

- **Practice address:** 2459 W JONATHAN MOORE PIKE, COLUMBUS, IN 47201-9206
- **Practice address phone:** (812) 516-5777
- **Practice address fax:** (812) 531-1177
- **Mailing address:** 2459 W JONATHAN MOORE PIKE, COLUMBUS, IN 47201-9206
- **Mailing address phone:** (812) 516-5777
- **Mailing address fax:** (812) 531-1177

## Taxonomy

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

## Other

- **Enumeration date:** 01/07/2022
- **Last updated:** 01/07/2022