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General NPI Number Information
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NPI Number | 1538557640
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Entity Type | Organization
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Legal Business Name | GLOW COMPREHENSIVE DENTISTRY, PC
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 850 W HAPPY CANYON RD
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City | CASTLE ROCK
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State | CO
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Zip | 80108-3908
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Country | US
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Telephone | 303-688-5705
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Fax | 303-688-5731
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Provider Business Mailing Address
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Address Line | 850 W HAPPY CANYON RD
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City | CASTLE ROCK
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State | CO
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Zip | 80108-3908
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Country | US
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Telephone | 303-688-5705
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Fax | 303-688-5731
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Authorized Official
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Title or Position | OWNER
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Name | CHUCK SKINNER
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Credential |
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Telephone | 907-350-3815
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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 | 10093
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License Number State | CO
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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 | 10514
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License Number State | CO
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