Concord Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CONCORD DENTAL, LLC

Practice address

2304 Concord Pike
Wilmington, DE 19803-2912

Phone

(302) 791-3750

NPI assigned

Oct 4, 2018

Organization subpart

No

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

Authorized official

Name

Glen Goleburn, DMD

Title

Dentist

Phone

(302) 836-3750

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1306311519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PEOPLES PLZ",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197025701",
            "telephone_number": "302-392-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 CONCORD PIKE",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198032912",
            "telephone_number": "302-791-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORD DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-04",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "GOLEBURN",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "302-836-3750",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122300000X",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katrina A Conard, MD
• Anna Mariah Conaway, CADC
• Concord Behavioral Health
• Concord Behavioral Health
• Concord Chiropractic
• Concord Health and Rehabilitation
• Concord Medical Inc.
• Anniya Larae Coney, CD
• Dana Leslie Conklin-Malusa, LMSW
• Gilbert Reid Conley, DPM

• Dental Clinic/Center in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Dental Clinic/Center in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.