Provider Demographics
NPI:1609913136
Name:GLASSMAN, DAVID MARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARON
Last Name:GLASSMAN
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 1:3055 HARBOR DR
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2460
Mailing Address - Country:US
Mailing Address - Phone:954-525-1101
Mailing Address - Fax:954-525-1104
Practice Address - Street 1:3055 HARBOR DR
Practice Address - Street 2:SUITE 1101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2460
Practice Address - Country:US
Practice Address - Phone:954-525-1101
Practice Address - Fax:954-525-1104
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 40931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics