Provider Demographics
NPI:1538227517
Name:WENGER, GLENN LAMAR (DMD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LAMAR
Last Name:WENGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MEADOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-1804
Mailing Address - Country:US
Mailing Address - Phone:610-827-9669
Mailing Address - Fax:
Practice Address - Street 1:60 MARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1843
Practice Address - Country:US
Practice Address - Phone:610-524-1141
Practice Address - Fax:610-363-3898
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022955-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice