Provider Demographics
NPI:1699041905
Name:GLOVER, DAWN K (DDS)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:GLOVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 TRINITY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2321
Mailing Address - Country:US
Mailing Address - Phone:505-662-5666
Mailing Address - Fax:505-661-0225
Practice Address - Street 1:2610 TRINITY DR STE 3
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2321
Practice Address - Country:US
Practice Address - Phone:505-626-5666
Practice Address - Fax:505-661-0225
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3998122300000X
390200000X
NMDD3868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program