Provider Demographics
NPI:1235829227
Name:GLENVINE DENTAL CARE INC
Entity Type:Organization
Organization Name:GLENVINE DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAPANTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-242-3328
Mailing Address - Street 1:945 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4205
Mailing Address - Country:US
Mailing Address - Phone:626-851-0388
Mailing Address - Fax:
Practice Address - Street 1:945 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4205
Practice Address - Country:US
Practice Address - Phone:626-851-0388
Practice Address - Fax:626-851-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty