Ann Lake Greenwell, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4717 Issued in KY

Practice address

555 S Floyd St
Louisville, KY 40202-3801

Phone

(502) 852-5312

Fax

(502) 852-5630

NPI assigned

Nov 19, 2005

Last updated

Jul 15, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1132358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247616000000",
    "number": "1912989302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S FLOYD ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023801",
            "telephone_number": "502-852-5312",
            "fax_number": "502-852-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S FLOYD ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023801",
            "telephone_number": "502-852-5312",
            "fax_number": "502-852-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWELL",
        "first_name": "ANN",
        "middle_name": "LAKE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-19",
        "last_updated": "2009-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "4717",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "4717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60047172",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greenlight4U LLC
• Greenwell Chiropractic Inc
• Greenwell Family Dentistry, PSC (Generations Family Dentistry)
• Amber Greenwell, RBT
• Angela Greenwell, RN, MSNA, CCRN, CRNA
• Constance S Greenwell, COTA
• Dana M Greenwell, DI
• Darren Scott Greenwell, DMD
• Derrick Greenwell
• Emily Greenwell, OTR/L

• Pediatric Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; 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.