Glenn J Evans Family Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

GLENN J EVANS FAMILY DENTAL

Practice address

1749 S Naperville Rd Ste 102
Wheaton, IL 60189-5892

Phone

(630) 260-1280

Fax

(630) 260-1233

NPI assigned

Mar 1, 2022

Last updated

Mar 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Glenn Evans, DDSNPI 1538142492

Title

President

Phone

(630) 362-8674

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn Jeffrey Evans, D.D.S.

  • Dentist
  • Wheaton, IL
  • NPI 1538142492
  NPD Authorized official

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1295481133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 PARKWAY DR",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873646",
            "telephone_number": "630-362-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 S NAPERVILLE RD STE 102",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601895892",
            "telephone_number": "630-260-1280",
            "fax_number": "630-260-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN J EVANS FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-362-8674",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538142492",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudia Glasgow, M.S., CF-SLP
• Jacklyn F Glass, MA, LPC
• John Glass
• Daniel Scott Gleason, LPC
• Glenn J Evans DDS PC
• Nicole Mary Glowacki
• Alex Godinez, MA
• Emma Jayne Goebel
• Mary Goebel
• Kristen Goerth

• Dentist in Wheaton, IL
• Providers in Wheaton, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.