Provider Demographics
NPI:1750623880
Name:GLENEAGLES DENTAL P.C.
Entity type:Organization
Organization Name:GLENEAGLES DENTAL P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-564-7253
Mailing Address - Street 1:4300 N. JOSEY LN.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:469-900-8153
Mailing Address - Fax:469-900-8156
Practice Address - Street 1:4300 N. JOSEY LN.
Practice Address - Street 2:SUITE 108
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:469-900-8153
Practice Address - Fax:469-900-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty