Individual
DR. GLENN JAMES JIVIDEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4300 LINDEN AVE, DAYTON, OH 45432-3022
(937) 259-0072
(937) 259-0383
Mailing address
4300 LINDEN AVE, DAYTON, OH 45432-3022
(937) 259-0072
(937) 259-0383
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
30-01-8124
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30-01-8124
STATE DENTAL LICENSE
OH
Enumeration date
05/23/2007
Last updated
07/08/2007
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