Center Grove Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CENTER GROVE DENTAL, LLC

Doing business as

Center Grove Dental

Practice address

4800 W Smith Valley Rd Ste K
Greenwood, IN 46142-9195

Phone

(317) 882-7800

Fax

(317) 893-2986

NPI assigned

Mar 12, 2019

Last updated

Mar 12, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sung H Kong, DDS

Title

Owner

Phone

(317) 882-7800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Center Grove Dental Doing business as

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1881152585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 W SMITH VALLEY RD STE K",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461429195",
            "telephone_number": "317-882-7800",
            "fax_number": "317-893-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 W SMITH VALLEY RD STE K",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461429195",
            "telephone_number": "317-882-7800",
            "fax_number": "317-893-2986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER GROVE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "KONG",
        "authorized_official_first_name": "SUNG",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-882-7800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200533220",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center Grove Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; 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.