Provider Demographics
NPI:1275761041
Name:UTZ, GLENN CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:CHARLES
Last Name:UTZ
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 1:1120 BOONE AIRE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1212
Mailing Address - Country:US
Mailing Address - Phone:859-371-6699
Mailing Address - Fax:
Practice Address - Street 1:1120 BOONE AIRE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1212
Practice Address - Country:US
Practice Address - Phone:859-371-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist