Glenn R Harris, DMD
Individual provider Active NPI General Practice Dentistry · Edgartown, MA
NPI 1730205352 · NPPES record last updated Aug 25, 2023
Key facts
- NPI
- 1730205352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN14867 (MA)
- Practice address
- 207 Upper Main St
Edgartown, MA 02539-5927 - Phone
- (508) 939-9000
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN14867 | MA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edgartown Dental Group LLC | General Practice | Past |
Accepting new patients |
| Main Street Dental | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN14867 | MA | Yes |
Addresses
Primary practice location
207 Upper Main St
Edgartown, MA 02539-5927
Mailing address
42 Evelyn Cir
Centerville, MA 02632-3438
Phone (508) 737-2880
Other providers in Edgartown, MA
- Eric Myles Gordon
- Kristen Grella
- Victoria Haeselbarth
- David A Halsey
- Sang Woo Han
- Island Health Inc.
- Island Health Inc.
- Island Health Inc.
- Ella Jernegan
- Judy L Jones
All providers in Edgartown, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.