Provider Demographics
NPI:1710900204
Name:GLADNICK, MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GLADNICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 KIRKWOOD HWY
Mailing Address - Street 2:KIRKWOOD-MILLTOWN PROFESSIONAL PLAZA
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5001
Mailing Address - Country:US
Mailing Address - Phone:302-994-2660
Mailing Address - Fax:302-994-6237
Practice Address - Street 1:5513 KIRKWOOD HWY
Practice Address - Street 2:KIRKWOOD-MILLTOWN PROFESSIONAL PLAZA
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5001
Practice Address - Country:US
Practice Address - Phone:302-994-2660
Practice Address - Fax:302-994-6237
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10000889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000883108Medicaid