Provider Demographics
NPI:1942244322
Name:GLASSMAN, JEFFREY I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
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 1:579 TREETOP LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5445 GRAND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1725
Practice Address - Country:US
Practice Address - Phone:847-244-2775
Practice Address - Fax:847-244-2777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice