Provider Demographics
NPI:1033341532
Name:GLENDALE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:GLENDALE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:CUKIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-386-2655
Mailing Address - Street 1:7407 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7433
Mailing Address - Country:US
Mailing Address - Phone:718-386-2655
Mailing Address - Fax:
Practice Address - Street 1:7407 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7433
Practice Address - Country:US
Practice Address - Phone:718-386-2655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05283411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty