Provider Demographics
NPI:1659551513
Name:IAN B. GLICK DMD & ALLISON G. RITCH DDS PC
Entity Type:Organization
Organization Name:IAN B. GLICK DMD & ALLISON G. RITCH DDS PC
Other - Org Name:ENDODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-687-3131
Mailing Address - Street 1:23 STILES RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2853
Mailing Address - Country:US
Mailing Address - Phone:603-893-3522
Mailing Address - Fax:
Practice Address - Street 1:23 STILES RD STE 106
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2853
Practice Address - Country:US
Practice Address - Phone:603-893-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11812OtherBLUE CROSS BLUE SHIELD MA