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General NPI Number Information
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NPI Number | 1073794418
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Entity Type | Organization
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Legal Business Name | GLOSMAN DENTAL GROUP, LTD
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 1351 W SUNSET RD #100
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City | HENDERSON
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State | NV
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Zip | 89014-8608
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Country | US
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Telephone | 702-835-1100
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Fax | 702-835-1101
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Provider Business Mailing Address
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Address Line | 833 W WHITTIER BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4735
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Country | US
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Telephone | 323-266-1000
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Fax | 323-372-1662
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Authorized Official
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Title or Position | CHEIF OF STAFF
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Name | MONIQUE R GOSMAN
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Credential | DDS
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Telephone | 310-480-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3580
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License Number State | NV
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