Provider Demographics
NPI:1295791549
Name:MARON, GLENN (DDS FACS)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:MARON
Suffix:
Gender:M
Credentials:DDS FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD STE 660
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2018
Mailing Address - Country:US
Mailing Address - Phone:404-892-2999
Mailing Address - Fax:404-815-7730
Practice Address - Street 1:999 PEACHTREE ST NE
Practice Address - Street 2:STE 715
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-892-2999
Practice Address - Fax:404-815-7730
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10345204E00000X
GA010345204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
19NCBPRMedicare ID - Type Unspecified
U19478Medicare UPIN