MEDICARE: E. GLENN GLASSMAN, D.D.S. PC DBA ORTHOCARE SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	013277	MO

General Provider Information

NPI Number	:	1053538504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E. GLENN GLASSMAN, D.D.S. PC DBA ORTHOCARE SYSTEMS

Provider Business Mailing Address
First Line	:	709 S 5TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2913
Country	:	US
Telephone Number	:	636-757-0770
Fax Number	:	636-757-0773

Provider Business Practice Location Address
First Line	:	6925 S LINDBERGH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4220
Country	:	US
Telephone Number	:	314-892-8550
Fax Number	:	314-892-5403

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELLIOT GLENN GLASSMAN
Credential	:	DDS
Telephone Number	:	636-757-0770

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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