Healthcare Provider Details

I. General information

NPI: 1386752376
Provider Name (Legal Business Name): GLENN SCOTT KUPFER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date: 05/11/2007
Reactivation Date: 08/08/2014

III. Provider practice location address

4944 NW 97TH DR
CORAL SPRINGS FL
33076-2454
US

IV. Provider business mailing address

4944 NW 97TH DR
CORAL SPRINGS FL
33076-2454
US

V. Phone/Fax

Practice location:
  • Phone: 954-803-5538
  • Fax:
Mailing address:
  • Phone: 954-803-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN9256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: