Healthcare Provider Details

I. General information

NPI: 1174657787
Provider Name (Legal Business Name): MARK JAMES GLECKNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BUCKWALTER PKWY
BLUFFTON SC
29910-5151
US

IV. Provider business mailing address

66 RIDGEDALE AVE
FLORHAM PARK NJ
07932-2006
US

V. Phone/Fax

Practice location:
  • Phone: 843-837-2035
  • Fax:
Mailing address:
  • Phone: 973-377-1174
  • Fax: 973-377-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI19917
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10279
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: