Provider Demographics
NPI:1659658474
Name:GLOVER, RICHARD W (DDS,MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 NOTT ST. EAST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-374-3060
Mailing Address - Fax:518-374-5278
Practice Address - Street 1:2310 NOTT ST. EAST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-374-3060
Practice Address - Fax:518-374-5278
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038561-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice