Individual
GLENN A HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6836
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059572
BCBS
VA
01
—
1350032
UMWA
—
Enumeration date
05/15/2006
Last updated
07/13/2026
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