Olive Branch Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

OLIVE BRANCH DENTAL LLC

Practice address

2826 S State Road 135 Ste C
Greenwood, IN 46143-9603

Phone

(317) 743-7777

Fax

(317) 854-6577

NPI assigned

Feb 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Srinivas Durshanapalli, DDS

Title

Managing Partner

Phone

(217) 303-5955

Specialties & licenses 1

Addresses

Other names 1

• Olive Branch Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vidhi Rakeshkumar Patel

  • Dentist
  • Greenwood, IN
  • NPI 1689308538
  NPD
• Han NA Park, DDS

  • Dentist
  • Lafayette, IN
  • NPI 1083341390
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1053904409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2826 S STATE ROAD 135 STE C",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 S STATE ROAD 135 STE C",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439603",
            "telephone_number": "317-743-7777",
            "fax_number": "317-854-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "DURSHANAPALLI",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "217-303-5955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olive Branch Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Olive Branch Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Ogle
• Sandra Obianuju Ogungbemi, MD
• Mayra Ojeda, RBT
• Mary Kaleigh Okerson, AGCNS-BC
• Bode Oladipo
• Christina Oliver, FNP-APRN
• Victoria Anne Oliver
• Linda Oliveski, L.M.T.
• Kelsey Elizabeth Olsen
• Olamigoke David Omotayo

• General Practice Dentistry in Greenwood, IN
• Providers in Greenwood, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.