Active NPI
Michael Glenn
- Endodontics
- Carlsbad, CA
National Provider Identifier
1902489891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DDS112542
- Practice address
- 6971 El Camino Real
Carlsbad, CA 92009-4114 - Phone
- (760) 688-0791
- NPI assigned
- Apr 29, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Endodontics | 1223E0200X | DDS112542 | CA | Primary |
Addresses
Primary practice location
6971 El Camino Real
Carlsbad, CA 92009-4114
Mailing address
4499 Ohio St Apt 251
San Diego, CA 92116-4596
Phone (913) 486-2627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210712000971 | LA | Order and Referring Only - Dentist | 0244632479 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS112542 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775606400000",
"number": "1902489891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4499 OHIO ST APT 251",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921164596",
"telephone_number": "913-486-2627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6971 EL CAMINO REAL",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920094114",
"telephone_number": "760-688-0791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-29",
"last_updated": "2026-04-08",
"certification_date": "2026-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "DDS112542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carlsbad, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.