Provider Demographics
NPI:1376662254
Name:GLOVER DENTAL CENTRE' LLC
Entity Type:Organization
Organization Name:GLOVER DENTAL CENTRE' LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR-GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-883-3443
Mailing Address - Street 1:2607 GILLIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3003
Mailing Address - Country:US
Mailing Address - Phone:229-883-3443
Mailing Address - Fax:229-883-6755
Practice Address - Street 1:2607 GILLIONVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3003
Practice Address - Country:US
Practice Address - Phone:229-883-3443
Practice Address - Fax:229-883-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011294251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare