# PINEVIEW PRESCOTT DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PINEVIEW PRESCOTT DENTAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588322598
- **Legal business name:** PINEVIEW PRESCOTT DENTAL
- **Authorized official:** DR. KENNETH GLASS DDS. (OWNER/DOCTOR)
- **Authorized official phone:** (928) 445-9233

## Contact information

- **Practice address:** 680 GAIL GARDNER WAY, PRESCOTT, AZ 86305-0001
- **Practice address phone:** (928) 445-9233
- **Practice address fax:** (928) 445-1758
- **Mailing address:** 680 GAIL GARDNER WAY, PRESCOTT, AZ 86305-0001
- **Mailing address phone:** (928) 445-9233
- **Mailing address fax:** (928) 445-1758

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/07/2021
- **Last updated:** 12/07/2021