Individual
GLENN A. FAMILANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1230 PROGRESSIVE DR, SUITE 103, CHESAPEAKE, VA 23320-0203
(757) 962-0417
Mailing address
3849 BUNCH WALNUTS ROAD, CHESAPEAKE, VA 23322
(757) 962-0417
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411266
VA
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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