Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) |
| NPI Number | 1053595579 |
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| LBN Legal business name | MARK L GLYMAN MD DDS & ERIC D SWANSON MD DMD LTD | ||||||||
| Authorized official | BRENDA GABLER - (OFFICE MANAGER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 12/19/2007 | ||||||||
| Last updated | 01/23/2023 - About 3 years ago | ||||||||
| Identifiers |
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