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General NPI Number Information
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NPI Number | 1093800039
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Entity Type | Organization
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Legal Business Name | GLENN P. FRIAL, DDS, MS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 28202 CABOT RD SUITE 250
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-1250
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Country | US
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Telephone | 949-276-2105
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Fax | 949-276-2109
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Provider Business Mailing Address
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Address Line | 28202 CABOT RD SUITE 250
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-1250
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ORTHODONTIST
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Name | DR. GLENN P. FRIAL
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Credential | D.D.S., M.S.
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Telephone | 949-276-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 41012
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License Number State | CA
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