Provider Demographics
NPI:1386752376
Name:KUPFER, GLENN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:SCOTT
Last Name:KUPFER
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 1:5501 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4645
Mailing Address - Country:US
Mailing Address - Phone:954-341-0551
Mailing Address - Fax:954-341-3169
Practice Address - Street 1:5501 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4645
Practice Address - Country:US
Practice Address - Phone:954-341-0551
Practice Address - Fax:954-341-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-08-08
Deactivation Date:2007-05-11
Deactivation Code:
Reactivation Date:2014-08-08
Provider Licenses
StateLicense IDTaxonomies
FL92561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice