Individual
DR. GLEN W HISEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
221 FAIRWAY TER N, CLOVIS, NM 88101-3064
(505) 762-3711
(505) 762-4142
Mailing address
221 FAIRWAY TER N, CLOVIS, NM 88101-3064
(505) 762-3711
(505) 762-4142
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1748
NM
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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