Provider Demographics
NPI:1902246184
Name:HILL, CHARLOTTE REBECCA GLEESON (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:REBECCA GLEESON
Last Name:HILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:REBECCA
Other - Last Name:GLEESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13820 W NEWBERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JONESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2093
Mailing Address - Country:US
Mailing Address - Phone:321-759-1614
Mailing Address - Fax:
Practice Address - Street 1:13820 W NEWBERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669-2093
Practice Address - Country:US
Practice Address - Phone:321-759-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist