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General NPI Number Information
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NPI Number | 1942477153
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Entity Type | Organization
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Legal Business Name | GLENN FAMILY DENTISTRY, PROFESSIONAL LLC
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 3600 S BEELER ST SUITE 120
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City | DENVER
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State | CO
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Zip | 80237-1801
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Country | US
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Telephone | 303-779-2592
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Fax | 303-779-2522
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Provider Business Mailing Address
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Address Line | 3600 S BEELER ST SUITE 120
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City | DENVER
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State | CO
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Zip | 80237-1801
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Country | US
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Telephone | 303-779-2592
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Fax | 303-779-2522
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DEWAYNE LEE GLENN
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Credential | DDS
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Telephone | 303-779-2592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9518
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3462
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License Number State | CO
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