Provider Demographics
NPI:1235397019
Name:ALEX, GLENN CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:CHRISTOPHER
Last Name:ALEX
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 1:140 TRINITY PL
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-2100
Mailing Address - Country:US
Mailing Address - Phone:706-549-5678
Mailing Address - Fax:706-549-8010
Practice Address - Street 1:140 TRINITY PL
Practice Address - Street 2:BUILDING A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-2100
Practice Address - Country:US
Practice Address - Phone:706-549-5678
Practice Address - Fax:706-549-8010
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0105311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice