# GLENDALE FAMILY DENTISTRY, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Glendale Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013748615
- **Authorized official:** BRANDON STAFFORD DDS (OWNER)
- **Authorized official phone:** (507) 208-3987

## Contact information

- **Practice address:** 2620 E 62ND ST, INDIANAPOLIS, IN 46220-2934
- **Practice address phone:** (507) 208-3987
- **Mailing address:** 114 WALTER REMLEY DR, CRAWFORDSVILLE, IN 47933-3350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/13/2024
- **Last updated:** 08/13/2024