MEDICARE: DR. FALONA GLENN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7880	CO

General Provider Information

NPI Number	:	1154329191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FALONA GLENN DDS

Provider Business Mailing Address
First Line	:	16711 E LAKE AVE
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80016-3079
Country	:	US
Telephone Number	:	303-307-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 S CHAMBERS RD
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-5023
Country	:	US
Telephone Number	:	303-751-6916
Fax Number	:	303-751-4910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/01/2014

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