Provider Demographics
NPI:1356157762
Name:PEDIATRICS NORTH GLENSTONE LLC
Entity type:Organization
Organization Name:PEDIATRICS NORTH GLENSTONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-614-0000
Mailing Address - Street 1:1470 N GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2132
Mailing Address - Country:US
Mailing Address - Phone:417-614-0000
Mailing Address - Fax:
Practice Address - Street 1:1470 N GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2132
Practice Address - Country:US
Practice Address - Phone:417-614-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty