Provider Demographics
NPI:1710190533
Name:GLICK, ANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GLICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 PENN PLAZA
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:212-563-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051482-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice