GLENDALE DENTAL LLC (NPI# 1710478557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710478557 |
| Entity Type | Organization |
| Organization Name | GLENDALE DENTAL LLC |
| Practice Address |
5150 N Port Washington Rd Ste 201 Glendale WI 53217-5400 |
| Mailing Address |
920 Indian Spring Dr Delafield WI 53018-2242 |
| Practice Telephone | 4149648850 |
| Practice Fax Number | 4149648918 |
| Mailing Telephone | 2628730510 |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-05-29 |
| Authorized Official Name | CHRISTOPHER POTRYKUS (OWNER) |
| Authorized Official Telephone | 2626462771 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
6886 | WI | Ambulatory Health Care Facilities |
| Street Address |
5150 N PORT WASHINGTON RD STE 201 |
| City | GLENDALE |
| State | WI |
| Zip Code | 53217-5400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922632587 | Jasmine Dockery | Pharmacist | 5400 N Port Washington, Glendale, WI 53217 | 2020-02-23 |
| 1174017339 | North Lakes Nursing Home Health Care Agency LLC | Home Health | 225 E Fairmount Ave, Milwaukee, WI 53217 | 2018-06-20 |
| 1083140289 | Miriah Ann King, Ms, Lpc | Counselor | 7805 North Boyd Way, Fox Point, WI 53217 | 2017-05-08 |
| 1245783067 | Lakesha L Jones | Counselor | 5235 N Ironwood Rd, Glendale, WI 53217 | 2016-07-28 |
| 1750783312 | Ibrahim S Abouzeid | Specialist/Technologist, Other | 333 W Brown Deer Road, #240, Milwaukee, WI 53217 | 2014-09-25 |
| 1255733598 | Victoria Gorodetsky | Pharmacist | 229 W Indian Creek Ct, Milwaukee, WI 53217 | 2014-09-18 |
| 1174800049 | John Herman Esser | Internal Medicine | 1050 W Acacia Rd, Milwaukee, WI 53217 | 2011-11-07 |
| 1710298351 | Leann M Harman | Physical Therapist | 5333 N Port Washington Rd Ste B, Glendale, WI 53217 | 2010-06-29 |
| 1306012455 | Emily Marie Gallagher | Speech-Language Pathologist | 6700 N. Port Washington Road, Milwaukee, WI 53217 | 2008-05-07 |
| 1164625455 | Mary Catherine Enderlin | Psychologist | 6110 N Port Washington Road, The Cambridge Group, Glendale, WI 53217 | 2007-06-06 |
| Find all providers in zip 53217 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417564733 | Nova Bright Dental Group | Clinic/Center | 1000 N Central Ave Ste 130, Glendale, CA 91202-3686 | 2020-09-30 |
| 1780237925 | Peoria Dental1 LLC | Clinic/Center | 8285 W Union Hills Dr Ste 103, Glendale, AZ 85308-0511 | 2019-07-17 |
| 1609336320 | Valley of The Sun Dentistry P.l.l.c. | Clinic/Center | 18205 N 51st Ave Ste 155, Glendale, AZ 85308-1493 | 2019-03-20 |
| 1659848828 | Jg Dental Pllc | Clinic/Center | 4901 W Bell Rd Ste 140, Glendale, AZ 85308-3465 | 2018-10-25 |
| 1942775457 | Nathan P Tenney Dmd, Pllc | Clinic/Center | 18275 N 59th Ave # C-114, Glendale, AZ 85308-1260 | 2018-10-11 |
| 1992287445 | Paul Meserkhani Dds Inc | Clinic/Center | 620 E Glenoaks Blvd Ste B, Glendale, CA 91207 | 2018-08-31 |
| 1013401314 | James J Beck, Dds Inc. | Clinic/Center | 3424 N Verdugo Rd, Glendale, CA 91208-1529 | 2018-06-20 |
| 1629588249 | Vahe Boghossian D.m.d. Inc. | Clinic/Center | 332 E Glenoaks Blvd Ste 200, Glendale, CA 91207-2106 | 2017-10-10 |
| 1487032280 | Armine Harutyunyan Dds Inc | Clinic/Center | 1117 S Glendale Ave Ste B, Glendale, CA 91205-3270 | 2015-05-12 |
| 1578950325 | Karen Berrigan Dmd, Ms, PC | Clinic/Center | 20100 N 51st Ave Ste B230, Glendale, AZ 85308-5097 | 2015-04-20 |
| Find all providers in GLENDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.