Provider Demographics
NPI:1417107640
Name:BIVEN, GLENN MAMO (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MAMO
Last Name:BIVEN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:GLENN
Other - Middle Name:M
Other - Last Name:BIVEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:98211 PALI MOMI ST
Mailing Address - Street 2:#412
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-488-0822
Mailing Address - Fax:
Practice Address - Street 1:98211 PALI MOMI ST
Practice Address - Street 2:#412
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4318
Practice Address - Country:US
Practice Address - Phone:808-488-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics