Provider Demographics
NPI:1225288004
Name:JOEL T. GLUCK D.D.S. P.C.
Entity Type:Organization
Organization Name:JOEL T. GLUCK D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-352-2445
Mailing Address - Street 1:700 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-352-2445
Mailing Address - Fax:516-352-2855
Practice Address - Street 1:700 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-352-2445
Practice Address - Fax:516-352-2855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOEL T GLUCK D.D.S. P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0218781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty