Provider Demographics
NPI:1851347017
Name:STENQUIST, GLENN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:R
Last Name:STENQUIST
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 1:24515 HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018-2758
Mailing Address - Country:US
Mailing Address - Phone:573-796-3420
Mailing Address - Fax:
Practice Address - Street 1:1021 W BUCHANAN ST
Practice Address - Street 2:SUITE 18
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018-1238
Practice Address - Country:US
Practice Address - Phone:573-796-8686
Practice Address - Fax:573-796-5050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0160381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice