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Individual
GLEN D HOUSTON
Active
Individual
GLEN D HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
3753
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800522089
GROUP MEDICARE
OK
Enumeration date
03/14/2006
Last updated
12/09/2021
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