Provider Demographics
NPI:1477636744
Name:GAYLE GLENN DDS MSD PA
Entity Type:Organization
Organization Name:GAYLE GLENN DDS MSD PA
Other - Org Name:GAYLE GLENN DDS MSD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:214-696-3082
Mailing Address - Street 1:8325 WALNUT HILL LN
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4208
Mailing Address - Country:US
Mailing Address - Phone:214-696-3082
Mailing Address - Fax:214-696-4607
Practice Address - Street 1:8325 WALNUT HILL LN
Practice Address - Street 2:SUITE 111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4208
Practice Address - Country:US
Practice Address - Phone:214-696-3082
Practice Address - Fax:214-696-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty