Healthcare Provider Details

I. General information

NPI: 1518970441
Provider Name (Legal Business Name): GLENN BANKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 NORTH FWY
HOUSTON TX
77076-4701
US

IV. Provider business mailing address

16210 TAHOE DR
JERSEY VILLAGE TX
77040-1250
US

V. Phone/Fax

Practice location:
  • Phone: 713-697-9100
  • Fax:
Mailing address:
  • Phone: 281-606-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22493
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: