Provider Demographics
NPI:1376872622
Name:GLIDDEN, TANYA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRICKYARD LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1604
Mailing Address - Country:US
Mailing Address - Phone:207-363-7270
Mailing Address - Fax:
Practice Address - Street 1:11 BRICKYARD LN
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1604
Practice Address - Country:US
Practice Address - Phone:207-363-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics