Brian Glesne, D.M.D

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Practice address

3307 Griffin Ave
Pekin, IL 61554-6237

Phone

(309) 347-3066

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417006511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3307 GRIFFIN AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3307 GRIFFIN AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546237",
            "telephone_number": "309-347-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLESNE",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy C Getz, RD, BS, LD
• Jessica Gheewala, PA-C
• Molly Rose Giamette, MA, LPC
• GK Enterprise LLC
• Melissa Marie Glass, APRN-FPA
• Kurt Larson Glesne, D.P.M.
• Mark Evan Glesne, DDS
• GNL Merchandising
• Hassan Golchini, MD
• Leora M Gomez

• Public Health Dentistry in Pekin, IL
• Providers in Pekin, IL by specialty
• Public Health Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.