Provider Demographics
NPI:1679590244
Name:MCREYNOLDS, GLENN CURTIS (DDS)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:CURTIS
Last Name:MCREYNOLDS
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 1:5320 WILL RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-5430
Mailing Address - Country:US
Mailing Address - Phone:915-751-3600
Mailing Address - Fax:915-757-1146
Practice Address - Street 1:5320 WILL RUTH AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-5430
Practice Address - Country:US
Practice Address - Phone:915-751-3600
Practice Address - Fax:915-757-1146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice