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NPI Code Detail

MEDICARE: DR. GERALD GLENN D.D.S.

MEDICARE: DR. GERALD GLENN 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
11223G0001XGeneral Practice Dentistry7825CO

General Provider Information

NPI Number : 1558369504
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERALD GLENN D.D.S.
Provider Business Mailing Address
First Line : 2675 S ABILENE ST STE 135
Second Line :
City : AURORA
State : CO
Zip : 80014-2363
Country : US
Telephone Number : 303-751-6916
Fax Number :
Provider Business Practice Location Address
First Line : 2675 S ABILENE ST STE 135
Second Line :
City : AURORA
State : CO
Zip : 80014-2363
Country : US
Telephone Number : 303-751-6916
Fax Number : 303-751-4910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 07/27/2021

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