MEDICARE: JEFFREY W GLYNN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801353206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY W GLYNN

Provider Business Mailing Address
First Line	:	NORTH CANTON - GLYNN FAMILY DENTAL
Second Line	:	129 EASTON ST NE
City	:	NORTH CANTON
State	:	OH
Zip	:	44721
Country	:	US
Telephone Number	:	330-494-3400
Fax Number	:	330-497-3404

Provider Business Practice Location Address
First Line	:	NORTH CANTON - GLYNN FAMILY DENTAL
Second Line	:	129 EASTON ST NE
City	:	NORTH CANTON
State	:	OH
Zip	:	44721
Country	:	US
Telephone Number	:	330-494-3400
Fax Number	:	330-497-3404

Authorized Official
Title or Position	:	OWNER, DENTIST
Name	:	JEFFREY W GLYNN
Credential	:	DDS
Telephone Number	:	614-843-7263

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	05/08/2019

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