Provider Demographics
NPI:1639375975
Name:GLENN S. PARRY, DMD, PC
Entity Type:Organization
Organization Name:GLENN S. PARRY, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:307-875-7770
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-1002
Mailing Address - Country:US
Mailing Address - Phone:307-875-7770
Mailing Address - Fax:
Practice Address - Street 1:220 SHOSHONE AVE
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5468
Practice Address - Country:US
Practice Address - Phone:307-875-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty