Provider Demographics
NPI:1013099464
Name:GLOGAS FAMILY DENTISTRY, L.L.C.
Entity Type:Organization
Organization Name:GLOGAS FAMILY DENTISTRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GLOGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-426-8805
Mailing Address - Street 1:919 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-2354
Mailing Address - Country:US
Mailing Address - Phone:260-426-8805
Mailing Address - Fax:260-424-1028
Practice Address - Street 1:919 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-2354
Practice Address - Country:US
Practice Address - Phone:260-426-8805
Practice Address - Fax:260-424-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty