Provider Demographics
NPI:1063417418
Name:GLENN, JANET C (DDS, MAGD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:C
Last Name:GLENN
Suffix:
Gender:F
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 SIERRA DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:972-594-0022
Mailing Address - Fax:972-409-1000
Practice Address - Street 1:6550 SIERRA DRIVE
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039
Practice Address - Country:US
Practice Address - Phone:972-594-0022
Practice Address - Fax:972-409-1000
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14637122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist