Provider Demographics
NPI:1598179772
Name:GLYNN, ANDREW RHOADS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RHOADS
Last Name:GLYNN
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 1:21 MDS/SGOD
Mailing Address - Street 2:ATTN: DENTAL CLINIC
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-567-5065
Mailing Address - Fax:719-567-5115
Practice Address - Street 1:559 VINCENT ST BLDG 959
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-567-5065
Practice Address - Fax:719-567-5115
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024179122300000X
CODEN.00203352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist