Healthcare Provider Details

I. General information

NPI: 1932675279
Provider Name (Legal Business Name): JACLYN MARTHA GLEBER RDH, ED.D., PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 E LINCOLN HWY FL 1
COATESVILLE PA
19320-3590
US

IV. Provider business mailing address

4 ADELPHIA LN
CHESTER SPRINGS PA
19425-1702
US

V. Phone/Fax

Practice location:
  • Phone: 610-716-6525
  • Fax: 610-380-4664
Mailing address:
  • Phone: 610-827-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH000185
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: