Provider Demographics
NPI:1720171424
Name:STEPHENS, GLENN OREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:OREN
Last Name:STEPHENS
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 1:3427 POLO DOWNS
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3371
Mailing Address - Country:US
Mailing Address - Phone:205-612-7328
Mailing Address - Fax:
Practice Address - Street 1:2030 PATTON CHAPEL ROAD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-979-9491
Practice Address - Fax:205-979-5439
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL79578OtherBSBS OF ALABAMA
AL741927OtherUNITED CONCORDIA