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Organization
GLISTEN DENTAL LLC
Active
Organization
GLISTEN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REVAN DAWOOD DMD (DENTIST)
(623) 262-4372
Entity
Organization
Contact information
Practice address
4365 E PECOS RD STE 127, GILBERT, AZ 85295-8052
(480) 331-4955
Mailing address
4365 E PECOS RD STE 127, GILBERT, AZ 85295-8052
(480) 331-4955
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
NULL
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
NULL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
NULL
Other
Enumeration date
08/05/2022
Last updated
09/13/2026
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