Provider Demographics
NPI:1255358297
Name:HEBERT, GLEN FRANCES (DDS)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:FRANCES
Last Name:HEBERT
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 1:1316 COFFEE RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3191
Mailing Address - Country:US
Mailing Address - Phone:209-527-5455
Mailing Address - Fax:209-527-7131
Practice Address - Street 1:1316 COFFEE RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3191
Practice Address - Country:US
Practice Address - Phone:209-527-5455
Practice Address - Fax:209-527-7131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice