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General NPI Number Information
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NPI Number | 1083735195
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Entity Type | Organization
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Legal Business Name | P A GLIDDEN FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 SUPERIOR ST
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City | SANDPOINT
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State | ID
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Zip | 83864-1394
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Country | US
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Telephone | 208-263-8514
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Fax |
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Provider Business Mailing Address
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Address Line | 103 SUPERIOR ST
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City | SANDPOINT
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State | ID
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Zip | 83864-1394
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Country | US
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Telephone | 208-263-8514
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP ARNOLD GLIDDEN
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Credential | DDS
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Telephone | 208-263-8514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D1968
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License Number State | ID
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