Provider Demographics
NPI:1649389420
Name:MEAD, GLENN ARTHUR (DDS)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ARTHUR
Last Name:MEAD
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 1:129 NORTH THIRD SUITE B
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080
Mailing Address - Country:US
Mailing Address - Phone:405-527-6568
Mailing Address - Fax:405-527-6569
Practice Address - Street 1:129 NORTH THIRD SUITE B
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080
Practice Address - Country:US
Practice Address - Phone:405-527-6568
Practice Address - Fax:405-527-6569
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK3856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist