Provider Demographics
NPI:1417022096
Name:GLENWOOD FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:GLENWOOD FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-527-3144
Mailing Address - Street 1:514 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534
Mailing Address - Country:US
Mailing Address - Phone:712-527-3144
Mailing Address - Fax:712-527-5900
Practice Address - Street 1:514 FIRST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534
Practice Address - Country:US
Practice Address - Phone:712-527-3144
Practice Address - Fax:712-527-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122300000X
NE122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty