Provider Demographics
NPI:1306990544
Name:GLASER, JON EVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:EVAN
Last Name:GLASER
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 1:4833 N LEE RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3288
Mailing Address - Country:US
Mailing Address - Phone:561-865-3668
Mailing Address - Fax:
Practice Address - Street 1:1700 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6346
Practice Address - Country:US
Practice Address - Phone:561-737-3200
Practice Address - Fax:561-364-9775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0638817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist