Provider Demographics
NPI:1962660795
Name:GLENN C. ALEX, D.M.D.
Entity Type:Organization
Organization Name:GLENN C. ALEX, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-549-5678
Mailing Address - Street 1:140 TRINITY PL
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-2100
Mailing Address - Country:US
Mailing Address - Phone:706-549-5678
Mailing Address - Fax:706-549-8010
Practice Address - Street 1:140 TRINITY PL
Practice Address - Street 2:BUILDING A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-2100
Practice Address - Country:US
Practice Address - Phone:706-549-5678
Practice Address - Fax:706-549-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010531261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental