| Gleam Dental Llc | |
|
3636 N. Macaurthur Ste 140 Irving TX 75062 | |
| (972) 573-6100 | |
| (972) 573-6105 |
| Full Name | Gleam Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 3636 N. Macaurthur, Irving, Texas |
| Authorized Official Name and Position | Field G. Harrison (OWNER/PROVIDER) |
| Authorized Official Contact | 9725736100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gleam Dental Llc 3636 N. Macaurthur Ste. 140 Irving TX 75062 Ph: (972) 573-6100 | Gleam Dental Llc 3636 N. Macaurthur Ste 140 Irving TX 75062 Ph: (972) 573-6100 |
| NPI Number | 1679846083 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 02/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679846083 | NPI | - | NPPES |
| TPI205977609 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 122300000X | Dentist | 23874 (Texas) | Primary |
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