Provider Demographics
NPI:1811315625
Name:GLENN A. MACFARLANE, D.M.D.
Entity type:Organization
Organization Name:GLENN A. MACFARLANE, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACFARLANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-530-4020
Mailing Address - Street 1:211 BROAD ST STE 106
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2009
Mailing Address - Country:US
Mailing Address - Phone:732-517-7785
Mailing Address - Fax:732-284-3170
Practice Address - Street 1:211 BROAD ST STE 106
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2009
Practice Address - Country:US
Practice Address - Phone:732-517-7785
Practice Address - Fax:732-284-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15235332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies