Provider Demographics
NPI:1558354266
Name:GLICK, D (DDS)
Entity Type:Individual
Prefix:DR
First Name:D
Middle Name:
Last Name:GLICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22901 MILLCREEK BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5728
Mailing Address - Country:US
Mailing Address - Phone:216-464-9800
Mailing Address - Fax:
Practice Address - Street 1:22901 MILLCREEK BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5728
Practice Address - Country:US
Practice Address - Phone:216-464-9800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH388411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice