| Glide Dental | |
|
1813 W Harvard Ave Ste 221 Roseburg OR 97471-8704 | |
| (541) 672-6511 | |
| (541) 673-1892 |
| Full Name | Glide Dental |
|---|---|
| Speciality | Dentist |
| Location | 1813 W Harvard Ave Ste 221, Roseburg, Oregon |
| Authorized Official Name and Position | Jed R Norman (OWNER/DENTIST) |
| Authorized Official Contact | 5416726511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glide Dental 1813 W Harvard Ave Ste 221 Roseburg OR 97471-8704 Ph: (541) 672-6511 | Glide Dental 1813 W Harvard Ave Ste 221 Roseburg OR 97471-8704 Ph: (541) 672-6511 |
| NPI Number | 1902244619 |
|---|---|
| Provider Enumeration Date | 06/05/2013 |
| Last Update Date | 06/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902244619 | NPI | - | NPPES |
| 278647 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D8859 (Oregon) | Primary |
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