Organization
BRANDON GREENWALT DMD PLLC
Active
Other names
Greenwalt Family Dentistree
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON LEE GREENWALT DMD (PRESIDENT)
(317) 408-5764
Entity
Organization
Contact information
Practice address
12443 SAN JOSE BLVD STE 101, JACKSONVILLE, FL 32223-8647
(904) 262-6188
Mailing address
328 W KARI CT, JACKSONVILLE, FL 32259-3320
(317) 408-5764
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN19737
FL
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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