Provider Demographics
NPI:1558558692
Name:DIBARTOLOMEO, GLENN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JOSEPH
Last Name:DIBARTOLOMEO
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 1:590 PALM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7850
Mailing Address - Country:US
Mailing Address - Phone:407-830-8613
Mailing Address - Fax:407-331-8873
Practice Address - Street 1:590 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7850
Practice Address - Country:US
Practice Address - Phone:407-830-8613
Practice Address - Fax:407-331-8873
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00083771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice