Provider Demographics
NPI:1457955148
Name:GLENN, SARAH L (DDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:GLENN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 HIDALGO ST APT 222
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6456
Mailing Address - Country:US
Mailing Address - Phone:832-858-6617
Mailing Address - Fax:
Practice Address - Street 1:9824 FONDREN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-3648
Practice Address - Country:US
Practice Address - Phone:713-271-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice