Provider Demographics
NPI:1407881766
Name:FORHAN, GLENN WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:WILLIAM
Last Name:FORHAN
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 1:6327 ARGYLE FOREST BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6115
Mailing Address - Country:US
Mailing Address - Phone:904-772-8898
Mailing Address - Fax:904-778-3730
Practice Address - Street 1:6327 ARGYLE FOREST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6115
Practice Address - Country:US
Practice Address - Phone:904-772-8898
Practice Address - Fax:904-778-3730
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDNOO112581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice