Provider Demographics
NPI:1043369572
Name:GLADSON, RODNEY CLELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:CLELL
Last Name:GLADSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E. MAZON AVE
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-1539
Mailing Address - Country:US
Mailing Address - Phone:815-584-1000
Mailing Address - Fax:
Practice Address - Street 1:413 E. MAZON AVE
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-1539
Practice Address - Country:US
Practice Address - Phone:815-584-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice