MEDICARE: DR. GLENN WILLIAM HORRIGAN DDS

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	1223G0001X	General Practice Dentistry	039238	NY

General Provider Information

NPI Number	:	1568410405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN WILLIAM HORRIGAN DDS

Provider Business Mailing Address
First Line	:	2553 W CHURCH ST
Second Line	:
City	:	EDEN
State	:	NY
Zip	:	14057-1005
Country	:	US
Telephone Number	:	716-992-4215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2553 W CHURCH ST
Second Line	:
City	:	EDEN
State	:	NY
Zip	:	14057-1005
Country	:	US
Telephone Number	:	716-992-4215
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/23/2007

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