=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548962442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATELYN NICOLE GLAENZER DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2023
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10049 MANCHESTER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-1825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-671-4019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 EXECUTIVE ESTATES DR
-----------------------------------------------------
City | MILLSTADT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62260-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-578-3380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 2023026063
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------