Healthcare Provider Details

I. General information

NPI: 1427049022
Provider Name (Legal Business Name): MEREDETH M GLENN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GRAND ST
CROTON ON HUDSON NY
10520-2305
US

IV. Provider business mailing address

102 GRAND ST
CROTON ON HUDSON NY
10520-2305
US

V. Phone/Fax

Practice location:
  • Phone: 914-271-5696
  • Fax: 914-206-4849
Mailing address:
  • Phone: 914-271-5696
  • Fax: 914-206-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number049079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: