Active NPI
Glenn R. Edens, DMD
- General Practice Dentistry
- Easley, SC
National Provider Identifier
1598881211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 30-3104
- Practice address
- 104 Franklin Square Way
Easley, SC 29642-3715 - Phone
- (864) 859-7288
- Fax
- (864) 859-8100
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30-3104 | SC | Primary |
Addresses
Primary practice location
104 Franklin Square Way
Easley, SC 29642-3715
Mailing address
104 Franklin Square Way
Easley, SC 29642-3715
Phone (864) 859-7288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61906 | Other | SC | UNITED CONCORDIA |
Other names 1
- Glenn R, Edens DMD PA
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-3104 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598881211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 FRANKLIN SQUARE WAY",
"city": "EASLEY",
"state": "SC",
"postal_code": "296423715",
"telephone_number": "864-859-7288",
"fax_number": "864-859-8100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 FRANKLIN SQUARE WAY",
"city": "EASLEY",
"state": "SC",
"postal_code": "296423715",
"telephone_number": "864-859-7288",
"fax_number": "864-859-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDENS",
"first_name": "GLENN",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "30-3104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "61906",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GLENN",
"last_name": "EDENS DMD PA",
"middle_name": "R,",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Easley, SC
- Easley Physician Partners PLLC
- Easley Skilled Nursing, LLC (Fleetwood Post Acute)
- Easley Spine & Health, Inc. (Carolina Spine & Health)
- Candice Jane Easter, COTA
- Elizabeth Anne Eddy, RD, LDN
- Greg W Edens, MD
- Carl Carter Edge IV
- Heather Wright Edge, DMD
- Shawn Conley Edwards, DMD
- Elevate Audiology LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.