Provider Demographics
NPI:1407979859
Name:GLESSER, GARY LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LLOYD
Last Name:GLESSER
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 1:34301 23 MILE RD.
Mailing Address - Street 2:SUITE #140B
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047
Mailing Address - Country:US
Mailing Address - Phone:586-725-7571
Mailing Address - Fax:586-725-6671
Practice Address - Street 1:34301 23 MILE RD.
Practice Address - Street 2:SUITE #140B
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047
Practice Address - Country:US
Practice Address - Phone:586-725-7571
Practice Address - Fax:586-725-6671
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI113861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice