Provider Demographics
NPI:1972709442
Name:WOODLIEF, GLENN ELGIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ELGIN
Last Name:WOODLIEF
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 1:5021 OLD HWY 75
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-693-6415
Mailing Address - Fax:
Practice Address - Street 1:WARREN CORRECTIONAL INSTITUTION - COLLINS ROAD
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:NC
Practice Address - Zip Code:27553
Practice Address - Country:US
Practice Address - Phone:252-456-3400
Practice Address - Fax:252-456-2778
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice