Provider Demographics
NPI:1215010368
Name:DRS PERO & GLINKA LLC
Entity Type:Organization
Organization Name:DRS PERO & GLINKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-893-0708
Mailing Address - Street 1:5635 MONCLOVA
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1876
Mailing Address - Country:US
Mailing Address - Phone:419-893-0708
Mailing Address - Fax:419-893-2860
Practice Address - Street 1:5635 MONCLOVA
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1876
Practice Address - Country:US
Practice Address - Phone:419-893-0708
Practice Address - Fax:419-893-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138061223P0221X
OH140811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304325Medicaid