Provider Demographics
NPI:1720221807
Name:GLICK DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GLICK DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:440-349-1400
Mailing Address - Street 1:28200 MILES RD. UNIT C
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139
Mailing Address - Country:US
Mailing Address - Phone:440-349-1400
Mailing Address - Fax:440-349-0558
Practice Address - Street 1:28200 MILES RD. UNIT C
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139
Practice Address - Country:US
Practice Address - Phone:440-349-1400
Practice Address - Fax:440-349-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.017346261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831101435OtherGENERAL DENTISTRY