Provider Demographics
NPI:1730218603
Name:COCOROS, GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:COCOROS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 POINTER RIDGE PL
Mailing Address - Street 2:SUITE K
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1875
Mailing Address - Country:US
Mailing Address - Phone:301-249-9098
Mailing Address - Fax:302-269-9098
Practice Address - Street 1:1522 POINTER RIDGE PL
Practice Address - Street 2:SUITE K
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1875
Practice Address - Country:US
Practice Address - Phone:301-249-9098
Practice Address - Fax:302-269-9098
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD63931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice