Provider Demographics
NPI:1346276151
Name:GLENN, STEPHEN O (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:O
Last Name:GLENN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5319 S LEWIS AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6500
Mailing Address - Country:US
Mailing Address - Phone:918-748-8484
Mailing Address - Fax:918-744-0761
Practice Address - Street 1:5319 S LEWIS AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6500
Practice Address - Country:US
Practice Address - Phone:918-748-8484
Practice Address - Fax:918-744-0761
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice