MEDICARE: DR. CHELSEA GLISSMAN DDS

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	1223G0001X	General Practice Dentistry	105159	CA

General Provider Information

NPI Number	:	1053922534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHELSEA GLISSMAN DDS

Provider Business Mailing Address
First Line	:	8700 TUDSBURY RD
Second Line	:
City	:	LOOMIS
State	:	CA
Zip	:	95650-9717
Country	:	US
Telephone Number	:	916-749-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 STANFORD RANCH RD STE 110
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4389
Country	:	US
Telephone Number	:	916-435-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	01/11/2024

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