NPIMap

Individual provider Active NPI

Glenn Canares, D.D.S.

  • Pediatric Dentistry
  • Baltimore, MD
National Provider Identifier
1174814537
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
15526 Issued in MD
Practice address
650 W Baltimore St
Baltimore, MD 21201
Phone
(410) 706-7970
Fax
(410) 706-4031
NPI assigned
Apr 20, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DEN03190 RI
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Dentistry 1223P0221X 15526 MD Primary

Addresses

Primary practice location

650 W Baltimore St
Baltimore, MD 21201

Mailing address

650 W Baltimore St RM 2210
Baltimore, MD 21201-1510
Phone (410) 706-7970

Other practice location 1

1811 Crain Hwy S
Glen Burnie, MD 21061-5561
Phone (410) 760-4455

Other practice location 2

4863 Pulaski Hwy Ste 200
Perryville, MD 21903-1624
Phone (410) 378-9696

Other identifiers 1

IdentifierTypeStateIssuer
081066500MedicaidMD

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
15526MDMDPediatric Dentist
DEN03190RIMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
West Cecil Health Center Inc. Past Accepting new patients
West Cecil Health Center Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: gcanares452738@direct.umm.edu
  • Direct secure messaging: glenn.canares.p1@direct.mcg-hhs.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1303257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174814537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W BALTIMORE ST RM 2210",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011510",
            "telephone_number": "410-706-7970",
            "fax_number": "410-706-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W BALTIMORE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "telephone_number": "410-706-7970",
            "fax_number": "410-706-4031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1811 Crain Hwy S",
            "address_purpose": "LOCATION",
            "city": "Glen Burnie",
            "state": "MD",
            "postal_code": "210615561",
            "country_code": "US",
            "telephone_number": "410-760-4455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4863 Pulaski Hwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Perryville",
            "state": "MD",
            "postal_code": "219031624",
            "country_code": "US",
            "telephone_number": "410-378-9696",
            "fax_number": "410-642-2023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANARES",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "RI",
            "license": "DEN03190",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "15526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081066500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.