Provider Demographics
NPI:1780996231
Name:GLASS, DENEEN ANN (RDH)
Entity type:Individual
Prefix:
First Name:DENEEN
Middle Name:ANN
Last Name:GLASS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:DENEEN
Other - Middle Name:ANN
Other - Last Name:HUDNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5318 N 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1614
Mailing Address - Country:US
Mailing Address - Phone:402-490-9552
Mailing Address - Fax:402-498-0885
Practice Address - Street 1:5318 N 97TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1614
Practice Address - Country:US
Practice Address - Phone:402-490-9552
Practice Address - Fax:402-498-0885
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1570124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist