Healthcare Provider Details

I. General information

NPI: 1174814537
Provider Name (Legal Business Name): GLENN CANARES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

650 W BALTIMORE ST RM 2210
BALTIMORE MD
21201-1510
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7970
  • Fax: 410-706-4031
Mailing address:
  • Phone: 410-706-7970
  • Fax: 410-706-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN03190
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15526
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: