Provider Demographics
NPI:1750379921
Name:ASHMORE, GLENN A (DDS)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:ASHMORE
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 1:3104 NW 23
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107
Mailing Address - Country:US
Mailing Address - Phone:405-949-0123
Mailing Address - Fax:405-949-9762
Practice Address - Street 1:3104 NW 23
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-949-0123
Practice Address - Fax:405-949-9762
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice