Provider Demographics
NPI:1578620639
Name:MACFARLANE, GLENN ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALAN
Last Name:MACFARLANE
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 1:211 BROAD STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2009
Mailing Address - Country:US
Mailing Address - Phone:732-517-7785
Mailing Address - Fax:732-284-3170
Practice Address - Street 1:211 BROAD ST STE 106
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2009
Practice Address - Country:US
Practice Address - Phone:732-517-7785
Practice Address - Fax:732-284-3170
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist