Glendale Family Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GLENDALE FAMILY DENTISTRY, LLC

Practice address

2620 E 62ND St
Indianapolis, IN 46220-2934

Phone

(507) 208-3987

NPI assigned

Aug 13, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brandon Stafford, DDSNPI 1417605742

Title

Owner

Phone

(507) 208-3987

Specialties & licenses 1

Addresses

Other names 1

• Glendale Family Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandon Joseph Stafford

  • General Practice Dentistry
  • Crawfordsville, IN
  • NPI 1417605742
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1013748615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 WALTER REMLEY DR",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479333350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 E 62ND ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462202934",
            "telephone_number": "507-208-3987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "STAFFORD",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-208-3987",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glendale Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyle Gleeson, DPM
• Alan Dean Gleghorn, TRANSPORTATION
• Glendale Advanced Health, LLC
• Glendale Chiropractic P.C.
• Glendale Dental Associates II, P.C.
• Glendale Family Eye Care, LLC
• Dawn Glenn, OTA
• Gary S Glenn, OD
• Kiara L Glenn
• Nancy M Glenn, NP

• Dental Clinic/Center in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dental Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.