Glenn James Jividen in Dayton - Periodontics
Glenn James Jividen - NPI 1750591590
Glenn James Jividen is a Periodontics in Dayton, Ohio. Glenn James Jividen practices all healthcare services and medical treatments related to Periodontics. The NPI Number for Glenn James Jividen is 1750591590. The last update date is 2007-07-08.
Glenn James Jividen's current location address is 4300 Linden Ave, Dayton, Ohio. You can contact this provider via phone number 9372590072 and fax number 9372590383. The mailing address for Glenn James Jividen is 4300 Linden Ave, Dayton, Ohio. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Glenn James Jividen |
|---|---|
| Address | 4300 Linden Ave, Dayton, Ohio |
| Phone Number | 9372590072 |
| Fax Number | 9372590383 |
| Sole Proprietor | N |
| Credentials | D.D.S. |
NPI Number Detail
| NPI Number | 1750591590 |
|---|---|
| Provider Enumeration Date | 2007-05-23 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 4300 Linden Ave |
|---|---|
| City | Dayton |
| State | Ohio (OH) |
| Post Code | 454323022 |
| Phone Number | 9372590072 |
| Fax Number | 9372590383 |
Provider's Primary Taxonomy Detail
| Speciality | Periodontics |
|---|---|
| Taxonomy | 1223P0300X |
| Licence No | 30-01-8124 |
|
Definition: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structure |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 30-01-8124 | OH | STATE DENTAL LICENSE |
Post Comment/ Review Below
What is the Glenn James Jividen's 1750591590?
The Glenn James Jividen's NPI (National Provider Identifier) Number is 1750591590. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Glenn James Jividen?
The Glenn James Jividen is physically situated at 4300 Linden Ave, in the city of Dayton, state of OH, with the postal code 454323022.
What is Glenn James Jividen's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Glenn James Jividen is Periodontics, and the taxonomy code that categorizes this field of expertise is 1223P0300X.
On what date did the Glenn James Jividen receive its 1750591590 assignment from the Centers for Medicare & Medicaid Services?
The Glenn James Jividen was assigned its 1750591590 by the Centers for Medicare & Medicaid Services on 2007-05-23.
When was the information related to Glenn James Jividen most recently updated or refreshed?
The details pertaining to the Glenn James Jividen, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-07-08.