Provider Demographics
NPI:1790237915
Name:STEPHEN E GLICK DDS PC
Entity Type:Organization
Organization Name:STEPHEN E GLICK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-784-4150
Mailing Address - Street 1:1600 HOCKETT RD
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2229
Mailing Address - Country:US
Mailing Address - Phone:804-784-4150
Mailing Address - Fax:804-784-1232
Practice Address - Street 1:1600 HOCKETT RD
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-2229
Practice Address - Country:US
Practice Address - Phone:804-784-4150
Practice Address - Fax:804-784-1232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty