MEDICARE: DR. JANET C GLENN DDS, MAGD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14637	TX
2	1223G0001X	General Practice Dentistry	14637	TX

General Provider Information

NPI Number	:	1063417418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET C GLENN DDS, MAGD

Provider Business Mailing Address
First Line	:	6550 SIERRA DRIVE
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039
Country	:	US
Telephone Number	:	972-594-0022
Fax Number	:	972-409-1000

Provider Business Practice Location Address
First Line	:	6550 SIERRA DRIVE
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039
Country	:	US
Telephone Number	:	972-594-0022
Fax Number	:	972-409-1000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/30/2011

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