Provider Demographics
NPI:1962676817
Name:STEPHEN O. GLENN, DDS
Entity Type:Organization
Organization Name:STEPHEN O. GLENN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-748-8484
Mailing Address - Street 1:5319 S LEWIS AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6500
Mailing Address - Country:US
Mailing Address - Phone:918-748-8484
Mailing Address - Fax:918-744-0761
Practice Address - Street 1:5319 S LEWIS AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6500
Practice Address - Country:US
Practice Address - Phone:918-748-8484
Practice Address - Fax:918-744-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3665261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental