Individual
GLEN D HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2701 COLTRANE PL STE 3, EDMOND, OK 73034-6783
(405) 715-4500
Mailing address
2701 COLTRANE PL STE 3, EDMOND, OK 73034-6783
(405) 715-4500
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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