Healthcare Provider Details

I. General information

NPI: 1528287232
Provider Name (Legal Business Name): GLOSMAN DENTAL GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 S. EASTERN AVE #130,
LAS VEGAS NV
89123-4834
US

IV. Provider business mailing address

833 W WHITTIER BLVD
MONTEBELLO CA
90640-4735
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-6606
  • Fax: 702-492-1580
Mailing address:
  • Phone: 323-266-1000
  • Fax: 323-859-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3580
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3580
License Number StateNV

VIII. Authorized Official

Name: MONIQUE R GLOSMAN
Title or Position: CHIEF OF STAFF
Credential: DDS
Phone: 310-480-2307