Provider Demographics
NPI:1588653729
Name:GLENN, DANIEL HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HAROLD
Last Name:GLENN
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 1:5955 CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-4416
Mailing Address - Country:US
Mailing Address - Phone:651-450-6111
Mailing Address - Fax:651-450-0668
Practice Address - Street 1:5955 CARMEN AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-4416
Practice Address - Country:US
Practice Address - Phone:651-450-6111
Practice Address - Fax:651-450-0668
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry