Provider Demographics
NPI:1316919145
Name:GLEIXNER, MARK ELIOTT (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ELIOTT
Last Name:GLEIXNER
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 1:1678 FRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1146
Mailing Address - Country:US
Mailing Address - Phone:317-885-7760
Mailing Address - Fax:317-885-7813
Practice Address - Street 1:1678 FRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1146
Practice Address - Country:US
Practice Address - Phone:317-885-7760
Practice Address - Fax:317-885-7813
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120083881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice