Provider Demographics
NPI:1568410405
Name:HORRIGAN, GLENN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:WILLIAM
Last Name:HORRIGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-1005
Mailing Address - Country:US
Mailing Address - Phone:716-992-4215
Mailing Address - Fax:
Practice Address - Street 1:2553 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-1005
Practice Address - Country:US
Practice Address - Phone:716-992-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0392381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice