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General NPI Number Information
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NPI Number | 1306848049
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Entity Type | Individual
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Provider Name | DAVID WILLIAM GLYNN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 8901 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone | 301-295-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 7008 FULTON ST
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4144
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Country | US
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Telephone | 301-986-1515
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401008490
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13494
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License Number State | MD
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