Healthcare Provider Details

I. General information

NPI: 1619997707
Provider Name (Legal Business Name): ANDREW REMINGTON GLENN DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 PLANTATION DR SUITE 100
LINCOLN NE
68516-4712
US

IV. Provider business mailing address

3401 PLANTATION DR SUITE 100
LINCOLN NE
68516-4712
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-3401
  • Fax: 402-421-3411
Mailing address:
  • Phone: 402-421-3401
  • Fax: 402-421-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6467
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number23254
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: