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General NPI Number Information
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NPI Number | 1114068939
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Entity Type | Organization
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Legal Business Name | GLENN BELEN, D.D.S. ELIZABETH VASCO, D.D.S., A.P.C.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 135 N SAN MATEO DR
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City | SAN MATEO
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State | CA
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Zip | 94401-2708
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Country | US
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Telephone | 650-344-7500
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Fax | 650-344-9019
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Provider Business Mailing Address
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Address Line | 135 N SAN MATEO DR
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City | SAN MATEO
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State | CA
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Zip | 94401-2708
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Country | US
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Telephone | 650-344-7500
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Fax | 650-344-9019
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GLENN BELEN
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Credential | D.D.S.
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Telephone | 650-344-7500
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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 | 30769
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License Number State | CA
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