=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346259165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENDA G PEOPLES-VERNIER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22855 KELLY RD
-----------------------------------------------------
City | EASTPOINTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48021-2057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-779-6777
-----------------------------------------------------
Fax | 586-779-0926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4848 DOW RIDGE RD
-----------------------------------------------------
City | ORCHARD LAKE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48324-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-706-7739
-----------------------------------------------------
Fax | 586-779-0926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 14454
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------