ELLIOTT GLENN, DDS

Endodontics · MILWAUKEE, WI

Individual Active Opted out of Medicare NPI 1942793104

Taxonomy & licensure

Specialty	Code	Primary	License	State
Endodontics	1223E0200X	✓	100226515	WI
Endodontics	1223E0200X		DDS-09873	IA
Student in an Organized Health Care Education/Training Program	390200000X		RES-30529	IA

Opted out of Medicare (Dentist), effective 2022-01-05 through 2028-01-05.

Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.