Provider Demographics
NPI:1982592671
Name:GLORE, CARSON TANNER (DMD)
Entity type:Individual
Prefix:DR
First Name:CARSON
Middle Name:TANNER
Last Name:GLORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3827
Mailing Address - Country:US
Mailing Address - Phone:706-587-7195
Mailing Address - Fax:
Practice Address - Street 1:2947 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3827
Practice Address - Country:US
Practice Address - Phone:706-955-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist