Provider Demographics
NPI:1588732945
Name:STAGNER, GLORIA GILMAN (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:GILMAN
Last Name:STAGNER
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 W OLLA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7983
Mailing Address - Country:US
Mailing Address - Phone:480-831-7209
Mailing Address - Fax:
Practice Address - Street 1:6601 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3794
Practice Address - Country:US
Practice Address - Phone:480-831-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5484124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist