Healthcare Provider Details

I. General information

NPI: 1548962442
Provider Name (Legal Business Name): KATELYN NICOLE GLAENZER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10049 MANCHESTER RD
SAINT LOUIS MO
63122-1825
US

IV. Provider business mailing address

6 EXECUTIVE ESTATES DR
MILLSTADT IL
62260-2200
US

V. Phone/Fax

Practice location:
  • Phone: 314-671-4019
  • Fax:
Mailing address:
  • Phone: 618-578-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2023026063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: