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General NPI Number Information
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NPI Number | 1104040039
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Entity Type | Individual
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Provider Name | GLENN KRIEGER DDS, FAGD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 4150 CALIFORNIA AVE SW
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City | SEATTLE
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State | WA
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Zip | 98116-4102
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Country | US
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Telephone | 206-935-1855
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Fax | 206-937-3996
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Provider Business Mailing Address
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Address Line | 5705 BUFFRIDGE TRL
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City | DALLAS
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State | TX
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Zip | 75252-2333
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Country | US
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Telephone | 469-610-9920
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Fax | 206-458-6093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30523
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License Number State | TX
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