Provider Demographics
NPI:1316584808
Name:GLENOS AND HADGIS ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:GLENOS AND HADGIS ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HADGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-283-1883
Mailing Address - Street 1:22 SAINT JOHNS MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5299
Mailing Address - Country:US
Mailing Address - Phone:904-797-6453
Mailing Address - Fax:
Practice Address - Street 1:22 SAINT JOHNS MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5299
Practice Address - Country:US
Practice Address - Phone:904-797-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty