Provider Demographics
NPI:1689714966
Name:GLUCK, THOMAS ERVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERVIN
Last Name:GLUCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11412 GUERLAC CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2591
Mailing Address - Country:US
Mailing Address - Phone:301-251-6637
Mailing Address - Fax:202-298-7760
Practice Address - Street 1:2506 VIRGINIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1902
Practice Address - Country:US
Practice Address - Phone:202-965-5400
Practice Address - Fax:202-298-7760
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN42701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice