Provider Demographics
NPI:1770631137
Name:GLOSSON, CHARLES RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:GLOSSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5746
Mailing Address - Country:US
Mailing Address - Phone:407-843-8180
Mailing Address - Fax:407-843-8924
Practice Address - Street 1:430 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5746
Practice Address - Country:US
Practice Address - Phone:407-843-8180
Practice Address - Fax:407-843-8924
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024170L1223E0200X
FLDN145781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics