Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN16726 | FL |
NPI | 1053387605 |
---|---|
Provider Name | Dr. Jennifer L Glassey |
First Address | Mt Pleasant, SC 29466-9266 |
Second Address | Manning, SC 29102-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 22/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
076011100 | (05) | FL |