Provider Demographics
NPI:1760405518
Name:HUDDLESTON, GLENN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:HUDDLESTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:68230 CALLE BONITA
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-4230
Mailing Address - Country:US
Mailing Address - Phone:760-329-2591
Mailing Address - Fax:760-340-0024
Practice Address - Street 1:73121 FRED WARING DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2868
Practice Address - Country:US
Practice Address - Phone:760-346-6273
Practice Address - Fax:760-340-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice