Provider Demographics
NPI:1528222874
Name:GLENN, ROBERT WEAVER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WEAVER
Last Name:GLENN
Suffix:
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:7001 A ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4299
Mailing Address - Country:US
Mailing Address - Phone:402-488-5275
Mailing Address - Fax:402-483-5200
Practice Address - Street 1:7001 A ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4299
Practice Address - Country:US
Practice Address - Phone:402-488-5275
Practice Address - Fax:402-483-5200
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2014-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE43511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060673900Medicaid