Provider Demographics
NPI:1003902925
Name:CHIARELLO, GLENN JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOHN
Last Name:CHIARELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 SOUTH END AVE
Mailing Address - Street 2:GROUND FLOOR SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1014
Mailing Address - Country:US
Mailing Address - Phone:212-321-1800
Mailing Address - Fax:212-432-1047
Practice Address - Street 1:375 SOUTH END AVE
Practice Address - Street 2:GROUND FLOOR SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1014
Practice Address - Country:US
Practice Address - Phone:212-321-1800
Practice Address - Fax:212-432-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040342-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice