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General NPI Number Information
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NPI Number | 1437834678
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Entity Type | Organization
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Legal Business Name | GLENWOOD FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 09/03/2023
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Provider Practice Location Address
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Address Line | 119 ELM
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City | GLENWOOD
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State | AR
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Zip | 71943-9213
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Country | US
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Telephone | 870-356-3920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 431
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City | GLENWOOD
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State | AR
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Zip | 71943-0431
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Country | US
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Telephone | 870-356-3920
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | CLAYTON SORRELLS
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Credential | DDS
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Telephone | 870-356-3920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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