Provider Demographics
NPI:1811105588
Name:ARGYLE DENTAL PROFESSIONALS INC.
Entity type:Organization
Organization Name:ARGYLE DENTAL PROFESSIONALS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FORHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-772-8898
Mailing Address - Street 1:6327 ARGYLE FOREST BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6115
Mailing Address - Country:US
Mailing Address - Phone:904-772-8898
Mailing Address - Fax:904-778-3730
Practice Address - Street 1:6327 ARGYLE FOREST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6115
Practice Address - Country:US
Practice Address - Phone:904-772-8898
Practice Address - Fax:904-778-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00112581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN0016196OtherDR. NGUYEN NUMBER
FLDN0011258OtherDENTAL LISCENCE NUMBER