Provider Demographics
NPI:1215057989
Name:GLOVER, MARK ERWIN (DDS,MSD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ERWIN
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 DOUGLAS AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5928
Mailing Address - Country:US
Mailing Address - Phone:214-691-5593
Mailing Address - Fax:
Practice Address - Street 1:8226 DOUGLAS AVE STE 601
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5928
Practice Address - Country:US
Practice Address - Phone:214-691-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics