Healthcare Provider Details

I. General information

NPI: 1497666200
Provider Name (Legal Business Name): GLISTEN DENTAL SCOTTSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 N HAYDEN RD UNIT C-104
SCOTTSDALE AZ
85260-5734
US

IV. Provider business mailing address

10615 N HAYDEN RD UNIT C-104
SCOTTSDALE AZ
85260-5734
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-4446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. REVAN DAWOOD
Title or Position: OWNER
Credential: DMD
Phone: 623-262-4372