Individual provider Active NPI

Mark James Gleckner, DMD

  • General Practice Dentistry
  • Bluffton, SC
National Provider Identifier
1174657787
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10279 Issued in SC
Practice address
370 Buckwalter Pkwy
Bluffton, SC 29910-5151
Phone
(843) 837-2035
NPI assigned
Mar 15, 2007
Last updated
Aug 31, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DI19917 NJ
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10279 SC Primary

Addresses

Primary practice location

370 Buckwalter Pkwy
Bluffton, SC 29910-5151

Mailing address

66 Ridgedale Ave
Florham Park, NJ 07932-2006
Phone (973) 377-1174

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DI19917NJMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1174657787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 RIDGEDALE AVE",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079322006",
            "telephone_number": "973-377-1174",
            "fax_number": "973-377-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 BUCKWALTER PKWY",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299105151",
            "telephone_number": "843-837-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLECKNER",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI19917",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bluffton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.