# GLISTEN DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104553478
- **Authorized official:** DR. REVAN DAWOOD DMD (DENTIST)
- **Authorized official phone:** (623) 262-4372

## Contact information

- **Practice address:** 4365 E PECOS RD STE 127, GILBERT, AZ 85295-8052
- **Practice address phone:** (480) 331-4955
- **Mailing address:** 4365 E PECOS RD STE 127, GILBERT, AZ 85295-8052
- **Mailing address phone:** (480) 331-4955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 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