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General NPI Number Information
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NPI Number | 1811789340
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Entity Type | Organization
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Legal Business Name | GLISTEN DENTAL GLENDALE
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 4901 W BELL RD STE 140
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City | GLENDALE
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State | AZ
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Zip | 85308-3416
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Country | US
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Telephone | 602-671-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 4365 E PECOS RD STE 127
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City | GILBERT
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State | AZ
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Zip | 85295-8052
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Country | US
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Telephone | 623-262-4372
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REVAN DAWOOD
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Credential | DMD
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Telephone | 623-262-4372
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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 |
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