Provider Demographics
NPI:1538498530
Name:DR. GLENN TRAUTMANN, D.M.D., P.A.
Entity Type:Organization
Organization Name:DR. GLENN TRAUTMANN, D.M.D., P.A.
Other - Org Name:STONEBRIDGE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:972-547-4141
Mailing Address - Street 1:1750 N STONEBRIDGE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7551
Mailing Address - Country:US
Mailing Address - Phone:972-547-4141
Mailing Address - Fax:972-547-1701
Practice Address - Street 1:1750 N STONEBRIDGE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7551
Practice Address - Country:US
Practice Address - Phone:972-547-4141
Practice Address - Fax:972-547-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty