Provider Demographics
NPI:1043213697
Name:GLICKMAN, JOEL MICHEAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MICHEAL
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 SOUTH CEDAR CREST BLVD.
Mailing Address - Street 2:SUITE 111C
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-432-1218
Mailing Address - Fax:610-432-1219
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:STE 111C
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-432-1218
Practice Address - Fax:610-432-1219
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA#DS-019337-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA#DS-019337-LOtherDENTAL LICENSE