Healthcare Provider Details

I. General information

NPI: 1255427563
Provider Name (Legal Business Name): GLENN EUGENE APPLETON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7742 OFFICE PARK BLVD STE A1
BATON ROUGE LA
70809-8636
US

IV. Provider business mailing address

7742 OFFICE PARK BLVD STE A1
BATON ROUGE LA
70809-8636
US

V. Phone/Fax

Practice location:
  • Phone: 225-201-1000
  • Fax: 225-201-1005
Mailing address:
  • Phone: 225-201-1000
  • Fax: 225-201-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberLA4679
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: