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General NPI Number Information
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NPI Number | 1790771871
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Entity Type | Individual
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Provider Name | GLENN ROBERT HEAD D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 6 POINTE CIR
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City | GREENVILLE
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State | SC
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Zip | 29615-3506
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Country | US
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Telephone | 864-233-1234
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Fax | 864-298-8009
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Provider Business Mailing Address
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Address Line | 6 POINTE CIR
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City | GREENVILLE
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State | SC
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Zip | 29615-3506
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Country | US
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Telephone | 864-233-1234
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Fax | 864-298-8009
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2868
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License Number State | SC
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