Provider Demographics
NPI:1992896294
Name:TRAUTMANN, GLENN (DMD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:TRAUTMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BLUE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9382
Mailing Address - Country:US
Mailing Address - Phone:972-347-9865
Mailing Address - Fax:972-347-9865
Practice Address - Street 1:1100 AIRPORT FWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6667
Practice Address - Country:US
Practice Address - Phone:817-267-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics