Provider Demographics
NPI:1013029230
Name:GLENNA K. SEQUEIRA DMD, PC
Entity Type:Organization
Organization Name:GLENNA K. SEQUEIRA DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:SEQUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-249-8771
Mailing Address - Street 1:2440 NE FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212
Mailing Address - Country:US
Mailing Address - Phone:503-249-8771
Mailing Address - Fax:503-249-8772
Practice Address - Street 1:2440 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212
Practice Address - Country:US
Practice Address - Phone:503-249-8771
Practice Address - Fax:503-249-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty