Provider Demographics
NPI:1477605582
Name:GLADSON, SETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:GLADSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEST DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1793
Mailing Address - Country:US
Mailing Address - Phone:636-532-1661
Mailing Address - Fax:866-262-1503
Practice Address - Street 1:4 WEST DR STE 150
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1793
Practice Address - Country:US
Practice Address - Phone:636-532-1661
Practice Address - Fax:866-262-1503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003-0185511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice