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General NPI Number Information
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NPI Number | 1740808211
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Entity Type | Organization
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Legal Business Name | ANDREW R GLENN DDS MD PC
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 3401 PLANTATION DR STE 100
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City | LINCOLN
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State | NE
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Zip | 68516-4712
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Country | US
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Telephone | 402-421-3401
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Fax | 402-421-3411
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Provider Business Mailing Address
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Address Line | 3401 PLANTATION DR STE 100
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City | LINCOLN
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State | NE
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Zip | 68516-4712
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Country | US
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Telephone | 402-421-3401
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Fax | 402-421-3411
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Authorized Official
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Title or Position | INSURANCE ADMINISTRATOR
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Name | DANIELLE BORUCH
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Credential |
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Telephone | 402-421-3401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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