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Organization
CONCORD DENTAL, LLC
Active
Organization
CONCORD DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN GOLEBURN DMD (DENTIST)
(302) 836-3750
Entity
Organization
Contact information
Practice address
2304 CONCORD PIKE, WILMINGTON, DE 19803-2912
(302) 791-3750
Mailing address
1250 PEOPLES PLZ, NEWARK, DE 19702-5701
(302) 392-2490
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122300000X
—
DE
Enumeration date
10/04/2018
Last updated
10/04/2018
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