Provider Demographics
NPI:1336391937
Name:GLUECK, CHARLES GEORGE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GEORGE
Last Name:GLUECK
Suffix:JR
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 1:4937 HEARST ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001
Mailing Address - Country:US
Mailing Address - Phone:504-454-8192
Mailing Address - Fax:
Practice Address - Street 1:4937 HEARST ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001
Practice Address - Country:US
Practice Address - Phone:504-454-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice