Provider Demographics
NPI:1740808211
Name:ANDREW R GLENN DDS MD PC
Entity type:Organization
Organization Name:ANDREW R GLENN DDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-3401
Mailing Address - Street 1:3401 PLANTATION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4712
Mailing Address - Country:US
Mailing Address - Phone:402-421-3401
Mailing Address - Fax:402-421-3411
Practice Address - Street 1:3401 PLANTATION DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4712
Practice Address - Country:US
Practice Address - Phone:402-421-3401
Practice Address - Fax:402-421-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty