Provider Demographics
NPI:1023230133
Name:GLENN PARK DDS PLLC
Entity type:Organization
Organization Name:GLENN PARK DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-583-3205
Mailing Address - Street 1:7 WELLS ST
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1200
Mailing Address - Country:US
Mailing Address - Phone:515-583-3205
Mailing Address - Fax:518-583-3205
Practice Address - Street 1:7 WELLS ST
Practice Address - Street 2:SUITE #205
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1200
Practice Address - Country:US
Practice Address - Phone:515-583-3205
Practice Address - Fax:518-583-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty