Provider Demographics
NPI:1932127099
Name:GLAZENER, C. FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:FRED
Last Name:GLAZENER
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 1:2681 STATE HIGHWAY 361
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-4200
Mailing Address - Country:US
Mailing Address - Phone:361-776-3535
Mailing Address - Fax:361-776-0222
Practice Address - Street 1:2681 STATE HIGHWAY 361
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-4200
Practice Address - Country:US
Practice Address - Phone:361-776-3535
Practice Address - Fax:361-776-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice