Provider Demographics
NPI:1124092580
Name:GLESMANN, DOUGLAS C (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:GLESMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:SUITE #207
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-649-3116
Mailing Address - Fax:248-649-6768
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:SUITE #207
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-649-3116
Practice Address - Fax:248-649-6768
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI130471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice