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General NPI Number Information
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NPI Number | 1356569875
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Entity Type | Organization
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Legal Business Name | GLENDALE DENTAL GROUP, L.T.D.
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4419 W GLENDALE AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-2804
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Country | US
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Telephone | 623-939-6549
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Fax | 623-939-3260
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Provider Business Mailing Address
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Address Line | 4419 W GLENDALE AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-2804
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Country | US
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Telephone | 623-939-6549
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Fax | 623-939-3260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY SALWIN
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Credential |
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Telephone | 623-939-6549
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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 | AZ3437
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License Number State | AZ
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