Individual
GLEN CONRAD HORNBUCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS FACD
Contact information
Practice address
8203 S WALKER AVE, OKLA CITY, OK 73139-9451
(405) 636-1411
(405) 636-1197
Mailing address
8203 S WALKER AVE, OKLA CITY, OK 73139-9451
(405) 636-1411
(405) 636-1197
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3816
OK
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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