Provider Demographics
NPI:1265574776
Name:GLOVER, WILLIAM A III (DMD, MAGD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:GLOVER
Suffix:III
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 S. HIAWASSEE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835
Mailing Address - Country:US
Mailing Address - Phone:407-522-5595
Mailing Address - Fax:407-522-5598
Practice Address - Street 1:1507 S HIAWASSE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-522-5595
Practice Address - Fax:407-522-5598
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072886100Medicaid