Provider Demographics
NPI:1053595579
Name:MARK L GLYMAN MD DDS & ERIC D SWANSON MD DMD LTD
Entity type:Organization
Organization Name:MARK L GLYMAN MD DDS & ERIC D SWANSON MD DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-892-0833
Mailing Address - Street 1:825 N GIBSON RD STE 441
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1708
Mailing Address - Country:US
Mailing Address - Phone:702-892-0833
Mailing Address - Fax:702-892-0906
Practice Address - Street 1:825 N GIBSON RD STE 441
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1708
Practice Address - Country:US
Practice Address - Phone:702-892-0833
Practice Address - Fax:702-892-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65021223S0112X, 204E00000X
NV91501223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF39939Medicare UPIN
NVU68908Medicare UPIN