1053538504 NPI number — E. GLENN GLASSMAN, D.D.S. PC DBA ORTHOCARE SYSTEMS

Table of content: (NPI 1053538504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053538504 NPI number — E. GLENN GLASSMAN, D.D.S. PC DBA ORTHOCARE SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E. GLENN GLASSMAN, D.D.S. PC DBA ORTHOCARE SYSTEMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053538504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6925 S LINDBERGH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63125-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-892-8550
Provider Business Practice Location Address Fax Number:
314-892-5403
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GLASSMAN
Authorized Official First Name:
ELLIOT
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-757-0770

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  013277 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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