Provider Demographics
NPI:1497470892
Name:PARKGLENN DENTAL
Entity Type:Organization
Organization Name:PARKGLENN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-431-6060
Mailing Address - Street 1:10371 PARKGLENN WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3871
Mailing Address - Country:US
Mailing Address - Phone:303-840-1900
Mailing Address - Fax:
Practice Address - Street 1:10371 PARKGLENN WAY STE 250
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3871
Practice Address - Country:US
Practice Address - Phone:303-840-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty