Provider Demographics
NPI:1356463152
Name:GLUCKMAN, DAVID J (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GLUCKMAN
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 1:3818 FAR WEST BLVD
Mailing Address - Street 2:#111
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3050
Mailing Address - Country:US
Mailing Address - Phone:572-345-1140
Mailing Address - Fax:512-345-1986
Practice Address - Street 1:3818 FAR WEST BLVD
Practice Address - Street 2:#111
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3050
Practice Address - Country:US
Practice Address - Phone:572-345-1140
Practice Address - Fax:512-345-1986
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD14184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX685062OtherUNITED CONCORDIA