Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1740808211 |
| LBN Legal business name | ANDREW R GLENN DDS MD PC |
| Authorized official | DANIELLE BORUCH - (INSURANCE ADMINISTRATOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 07/10/2020 |
| Last updated | 09/15/2021 - About 5 years ago |
| Identifiers | n/a |
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