Provider Demographics
NPI:1811105406
Name:GLENN R FOREMAN, DDS.,LTD
Entity type:Organization
Organization Name:GLENN R FOREMAN, DDS.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-443-3552
Mailing Address - Street 1:8147 E EVANS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3646
Mailing Address - Country:US
Mailing Address - Phone:480-443-3552
Mailing Address - Fax:480-443-8810
Practice Address - Street 1:8147 E EVANS RD STE 1
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3646
Practice Address - Country:US
Practice Address - Phone:480-443-3552
Practice Address - Fax:480-443-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty