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General NPI Number Information
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NPI Number | 1225002017
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Entity Type | Individual
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Provider Name | JEFFREY LAURENCE GLYNN DDS
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3450 S HUALAPAI WAY
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City | LAS VEGAS
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State | NV
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Zip | 89117-7707
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Country | US
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Telephone | 702-368-0305
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Fax | 702-368-0239
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Provider Business Mailing Address
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Address Line | 3450 S HUALAPAI WAY
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City | LAS VEGAS
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State | NV
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Zip | 89117-7707
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Country | US
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Telephone | 702-368-0305
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Fax | 702-368-0239
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2052
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License Number State | NV
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