Provider Demographics
NPI:1205810538
Name:CATRON, GLENN LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LEE
Last Name:CATRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 BEN BOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9706
Mailing Address - Country:US
Mailing Address - Phone:276-988-5554
Mailing Address - Fax:276-988-5555
Practice Address - Street 1:994 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9706
Practice Address - Country:US
Practice Address - Phone:276-988-5554
Practice Address - Fax:276-988-5555
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice