Provider Demographics
NPI:1255598710
Name:GLENDA JOSON DDS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GLENDA JOSON DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-375-5860
Mailing Address - Street 1:897 SAN MARCUS LN
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 W ARROW HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2330
Practice Address - Country:US
Practice Address - Phone:909-592-8338
Practice Address - Fax:909-592-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty