Provider Demographics
NPI:1083714588
Name:MEYER, GLEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:R
Last Name:MEYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E 4TH ST
Mailing Address - Street 2:SUITE 1175
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-4009
Mailing Address - Country:US
Mailing Address - Phone:513-621-1432
Mailing Address - Fax:513-621-0862
Practice Address - Street 1:105 E 4TH ST
Practice Address - Street 2:SUITE 1175
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-4009
Practice Address - Country:US
Practice Address - Phone:513-621-1432
Practice Address - Fax:513-621-0862
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist