Provider Demographics
NPI:1790825636
Name:LINCOLN, GLENN COMBS JR (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:COMBS
Last Name:LINCOLN
Suffix:JR
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5722 HAVENWOODS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-2319
Mailing Address - Country:US
Mailing Address - Phone:281-893-8888
Mailing Address - Fax:281-363-3088
Practice Address - Street 1:27840 I-45 NORTH
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:281-363-3088
Practice Address - Fax:281-363-3088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX75041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics