Provider Demographics
NPI:1487871372
Name:GLEN F EHRENMAN DDS AND MAHNAZ KHAN DDS PC
Entity type:Organization
Organization Name:GLEN F EHRENMAN DDS AND MAHNAZ KHAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:EHRENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-333-3033
Mailing Address - Street 1:959 BRUSH HOLLOW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1778
Mailing Address - Country:US
Mailing Address - Phone:516-333-3033
Mailing Address - Fax:516-333-3627
Practice Address - Street 1:959 BRUSH HOLLOW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1778
Practice Address - Country:US
Practice Address - Phone:516-333-3033
Practice Address - Fax:516-333-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty