| NPI | 1629638523 |
|---|---|
| Doing Business As | GLASS ROAD FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SHARON L LOSO Credentialing Specialist 563-552-0058 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2019-07-29 |