Healthcare Provider Details

I. General information

NPI: 1053595579
Provider Name (Legal Business Name): MARK L GLYMAN MD DDS & ERIC D SWANSON MD DMD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N GIBSON RD STE 441
HENDERSON NV
89011-1708
US

IV. Provider business mailing address

825 N GIBSON RD STE 441
HENDERSON NV
89011-1708
US

V. Phone/Fax

Practice location:
  • Phone: 702-892-0833
  • Fax: 702-892-0906
Mailing address:
  • Phone: 702-892-0833
  • Fax: 702-892-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6502
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9150
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number9150
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number6502
License Number StateNV

VIII. Authorized Official

Name: MS. BRENDA GABLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-892-0833