Provider Demographics
NPI:1215525001
Name:REDFORD, GLORIA JULIANA (DDS)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JULIANA
Last Name:REDFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 N CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64156-6323
Mailing Address - Country:US
Mailing Address - Phone:757-509-2411
Mailing Address - Fax:
Practice Address - Street 1:650 E 25TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:757-509-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist