Provider Demographics
NPI:1518042266
Name:GLICK, JASON SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:GLICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1 ROTARY CTR
Mailing Address - Street 2:1560 SHERMAN AVENUE, SUITE 610
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4469
Mailing Address - Country:US
Mailing Address - Phone:847-869-5417
Mailing Address - Fax:847-869-5509
Practice Address - Street 1:1 ROTARY CTR
Practice Address - Street 2:1560 SHERMAN AVENUE, SUITE 610
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4469
Practice Address - Country:US
Practice Address - Phone:847-869-5417
Practice Address - Fax:847-869-5509
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0210022851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry