Provider Demographics
NPI:1447256292
Name:STITSINGER JR., GLENN W (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:W
Last Name:STITSINGER JR.
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAURA CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1269
Mailing Address - Country:US
Mailing Address - Phone:513-887-1677
Mailing Address - Fax:
Practice Address - Street 1:110 LAURA CT
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1269
Practice Address - Country:US
Practice Address - Phone:513-887-1677
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-29841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice