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General NPI Number Information
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NPI Number | 1750623880
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Entity Type | Organization
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Legal Business Name | GLENEAGLES DENTAL P.C.
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 4300 N. JOSEY LN. SUITE 108
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City | CARROLLTON
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State | TX
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Zip | 75010
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Country | US
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Telephone | 469-900-8153
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Fax | 469-900-8156
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Provider Business Mailing Address
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Address Line | 4300 N. JOSEY LN. SUITE 108
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City | CARROLLTON
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State | TX
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Zip | 75010
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Country | US
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Telephone | 469-900-8153
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Fax | 469-900-8156
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DAVID SCOTT GERKIN
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Credential | DDS
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Telephone | 214-564-7253
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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 | 18119
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License Number State | TX
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