MEDICARE: DR. GLENN EUGENE APPLETON D.D.S.

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	LA4679	LA

General Provider Information

NPI Number	:	1255427563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN EUGENE APPLETON D.D.S.

Provider Business Mailing Address
First Line	:	7742 OFFICE PARK BLVD STE A1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-8636
Country	:	US
Telephone Number	:	225-201-1000
Fax Number	:	225-201-1005

Provider Business Practice Location Address
First Line	:	7742 OFFICE PARK BLVD STE A1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-8636
Country	:	US
Telephone Number	:	225-201-1000
Fax Number	:	225-201-1005

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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