Provider Demographics
NPI:1225002017
Name:GLYNN, JEFFREY LAURENCE (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LAURENCE
Last Name:GLYNN
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 1:3450 S HUALAPAI WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7707
Mailing Address - Country:US
Mailing Address - Phone:702-368-0305
Mailing Address - Fax:702-368-0239
Practice Address - Street 1:3450 S HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7707
Practice Address - Country:US
Practice Address - Phone:702-368-0305
Practice Address - Fax:702-368-0239
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist