Basic Information
| Provider Information | |||||||||
| NPI: | 1790846996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLOREN | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 CYPRESS POINT DR UNIT 7 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940434819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509617384 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WESTERN DENTAL | ||||||||
| Address2: | 975 VETERANS BLVD. | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503658900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 42849 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.