Provider Demographics
NPI:1932675279
Name:GLEBER, JACLYN MARTHA (RDH, EDD, PHDHP)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:MARTHA
Last Name:GLEBER
Suffix:
Gender:F
Credentials:RDH, EDD, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ADELPHIA LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-1702
Mailing Address - Country:US
Mailing Address - Phone:610-827-9369
Mailing Address - Fax:
Practice Address - Street 1:744 E LINCOLN HWY FL 1
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3590
Practice Address - Country:US
Practice Address - Phone:610-716-6525
Practice Address - Fax:610-380-4664
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
PAPHDH000185124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist