Healthcare Provider Details

I. General information

NPI: 1902246184
Provider Name (Legal Business Name): CHARLOTTE REBECCA GLEESON HILL D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLOTTE REBECCA GLEESON

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13820 W NEWBERRY RD SUITE 100
JONESVILLE FL
32669-2093
US

IV. Provider business mailing address

13820 W NEWBERRY RD SUITE 100
JONESVILLE FL
32669-2093
US

V. Phone/Fax

Practice location:
  • Phone: 321-759-1614
  • Fax:
Mailing address:
  • Phone: 321-759-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: