Provider Demographics
NPI:1881980969
Name:GLENN, MEREDITH TAYLOR EDGERTON (DDS)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:TAYLOR EDGERTON
Last Name:GLENN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1426 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0302
Practice Address - Country:US
Practice Address - Phone:910-256-9230
Practice Address - Fax:910-256-9004
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist