Provider Demographics
NPI:1558611582
Name:GLADNICK, THOMAS
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GLADNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 SHADY GROVE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3235
Mailing Address - Country:US
Mailing Address - Phone:301-963-0800
Mailing Address - Fax:
Practice Address - Street 1:15215 SHADY GROVE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3235
Practice Address - Country:US
Practice Address - Phone:301-963-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039333122300000X
MD15812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist