Provider Demographics
NPI:1689675670
Name:PALUMBO, GLENN JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOHN
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5655
Mailing Address - Country:US
Mailing Address - Phone:303-458-7061
Mailing Address - Fax:303-231-0979
Practice Address - Street 1:2599 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5655
Practice Address - Country:US
Practice Address - Phone:303-458-7061
Practice Address - Fax:303-231-0979
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist