Healthcare Provider Details

I. General information

NPI: 1033249826
Provider Name (Legal Business Name): DAVID G GLAZER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHURCH ST
YALESVILLE CT
06492-2253
US

IV. Provider business mailing address

11 STONEGATE CIR
CHESHIRE CT
06410-3461
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-5557
  • Fax:
Mailing address:
  • Phone: 203-272-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number005375
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: