Active NPI
Jeffrey Alan Glenn, D.D.S.
- Dentist
- Cincinnati, OH
National Provider Identifier
1073646840
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Mar 20, 2012.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19652
- Practice address
- 1665 California Ave
Cincinnati, OH 45237-5603 - Phone
- (513) 242-1999
- Fax
- (513) 242-6364
- NPI assigned
- Mar 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19652 | OH | Primary |
Addresses
Primary practice location
1665 California Ave
Cincinnati, OH 45237-5603
Mailing address
1665 California Ave
Cincinnati, OH 45237-5603
Phone (513) 242-1999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0943546 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19652 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1073646840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1665 CALIFORNIA AVE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452375603",
"telephone_number": "513-242-1999",
"fax_number": "513-242-6364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1665 CALIFORNIA AVE",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452375603",
"telephone_number": "513-242-1999",
"fax_number": "513-242-6364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "JEFFREY",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "19652",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0943546",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.