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NPI Code Detail

MEDICARE: DR. GLENN R. EDENS DMD

MEDICARE: DR. GLENN R. EDENS DMD
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 Dentistry30-3104SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161906OTHERSCUNITED CONCORDIA

General Provider Information

NPI Number : 1598881211
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN R. EDENS DMD
Provider Business Mailing Address
First Line : 104 FRANKLIN SQUARE WAY
Second Line :
City : EASLEY
State : SC
Zip : 29642-3715
Country : US
Telephone Number : 864-859-7288
Fax Number : 864-859-8100
Provider Business Practice Location Address
First Line : 104 FRANKLIN SQUARE WAY
Second Line :
City : EASLEY
State : SC
Zip : 29642-3715
Country : US
Telephone Number : 864-859-7288
Fax Number : 864-859-8100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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