1013099464 NPI number — GLOGAS FAMILY DENTISTRY, L.L.C.

Table of content: MISS CHRISTINE TRANG NGUYEN (NPI 1467793604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013099464 NPI number — GLOGAS FAMILY DENTISTRY, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOGAS FAMILY DENTISTRY, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013099464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 FLORENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46808-2354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-426-8805
Provider Business Mailing Address Fax Number:
260-424-1028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 FLORENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46808-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-426-8805
Provider Business Practice Location Address Fax Number:
260-424-1028
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLOGAS
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
260-426-8805

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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