Provider Demographics
NPI:1619096252
Name:GLUHAREFF, ALEX MICHAEL (DDS,MAGD,PA)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:MICHAEL
Last Name:GLUHAREFF
Suffix:
Gender:M
Credentials:DDS,MAGD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11223 N WILLIAMS ST
Mailing Address - Street 2:STE C
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432
Mailing Address - Country:US
Mailing Address - Phone:352-489-3922
Mailing Address - Fax:352-489-8462
Practice Address - Street 1:11223 N WILLIAMS ST
Practice Address - Street 2:STE C
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432
Practice Address - Country:US
Practice Address - Phone:352-489-3922
Practice Address - Fax:352-489-8462
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00109131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUNITED CONCORDIAOther134640
FLBCBSOther67539
FL6388550001Medicare NSC