MEDICARE: DR. DAVID MARON GLASSMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	DN 4093	FL

General Provider Information

NPI Number	:	1609913136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MARON GLASSMAN DDS

Provider Business Mailing Address
First Line	:	3055 HARBOR DR
Second Line	:	SUITE 1101
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2460
Country	:	US
Telephone Number	:	954-525-1101
Fax Number	:	954-525-1104

Provider Business Practice Location Address
First Line	:	3055 HARBOR DR
Second Line	:	SUITE 1101
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2460
Country	:	US
Telephone Number	:	954-525-1101
Fax Number	:	954-525-1104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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