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General NPI Number Information
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NPI Number | 1417022096
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Entity Type | Organization
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Legal Business Name | GLENWOOD FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 514 FIRST ST
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City | GLENWOOD
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State | IA
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Zip | 51534
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Country | US
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Telephone | 712-527-3144
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Fax | 712-527-5900
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Provider Business Mailing Address
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Address Line | 514 FIRST ST
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City | GLENWOOD
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State | IA
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Zip | 51534
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Country | US
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Telephone | 712-527-3144
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Fax | 712-527-5900
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Authorized Official
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Title or Position | DENTIST
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Name | PAUL ANDREW ALBERTSON
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Credential | DDS
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Telephone | 712-527-3144
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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 |
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License Number State | NE
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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 |
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License Number State | IA
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