Provider Demographics
NPI:1740441203
Name:BLOORE, GLENN E (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:BLOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 S BEVERLY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4808
Mailing Address - Country:US
Mailing Address - Phone:310-277-9700
Mailing Address - Fax:310-553-1825
Practice Address - Street 1:300 S BEVERLY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4808
Practice Address - Country:US
Practice Address - Phone:310-277-9700
Practice Address - Fax:310-553-1825
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA391341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics