NPIMap

Organization Active NPI

Glenwood Dental Association, LLP

  • Dentist
  • Smyma, DE
National Provider Identifier
1487664314
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
GI-0001103 Issued in DE
Legal business name
GLENWOOD DENTAL ASSOCIATION, LLP
Practice address
17 West Glenwood Avenue
Smyma, DE 19977
Phone
(302) 653-5011
Fax
(302) 653-8839
NPI assigned
Aug 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Tina M Shane
Title
Billing/Insurance
Phone
(302) 653-5011

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X GI-0000761 DE
Dentist 122300000X GI-0001103 DE Primary

Addresses

Primary practice location

17 West Glenwood Avenue
Smyma, DE 19977

Mailing address

17 West Glenwood Avenue
Smyma, DE 19977
Phone (302) 653-5011

National Provider Directory

National Provider Directory

Locations

17 W Glenwood Ave
Smyrna, DE 19977
Phone (302) 653-5011

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487664314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WEST GLENWOOD AVENUE",
            "city": "SMYMA",
            "state": "DE",
            "postal_code": "19977",
            "telephone_number": "302-653-5011",
            "fax_number": "302-653-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WEST GLENWOOD AVENUE",
            "city": "SMYMA",
            "state": "DE",
            "postal_code": "19977",
            "telephone_number": "302-653-5011",
            "fax_number": "302-653-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENWOOD DENTAL ASSOCIATION, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHANE",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING/INSURANCE",
        "authorized_official_telephone_number": "302-653-5011",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DE",
            "license": "GI-0000761",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DE",
            "license": "GI-0001103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.