Provider Demographics
NPI:1154329191
Name:GLENN, FALONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FALONA
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16711 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3079
Mailing Address - Country:US
Mailing Address - Phone:303-307-9788
Mailing Address - Fax:
Practice Address - Street 1:1732 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5023
Practice Address - Country:US
Practice Address - Phone:303-751-6916
Practice Address - Fax:303-751-4910
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice