Provider Demographics
NPI:1609931740
Name:GLICKSMAN & MARS DENTAL.LC
Entity Type:Organization
Organization Name:GLICKSMAN & MARS DENTAL.LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-935-2797
Mailing Address - Street 1:12634 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1712
Mailing Address - Country:US
Mailing Address - Phone:954-430-2300
Mailing Address - Fax:954-430-3119
Practice Address - Street 1:12634 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1712
Practice Address - Country:US
Practice Address - Phone:954-430-2300
Practice Address - Fax:954-430-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty