Healthcare Provider Details

I. General information

NPI: 1780996231
Provider Name (Legal Business Name): DENEEN ANN GLASS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DENEEN ANN HUDNOTT

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 N 97TH AVE
OMAHA NE
68134-1614
US

IV. Provider business mailing address

5318 N 97TH AVE
OMAHA NE
68134-1614
US

V. Phone/Fax

Practice location:
  • Phone: 402-490-9552
  • Fax: 402-498-0885
Mailing address:
  • Phone: 402-490-9552
  • Fax: 402-498-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1570
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: