Provider Demographics
NPI:1831101435
Name:GLICK, FRED (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:GLICK
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 DEERFOOT TRL
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9542
Mailing Address - Country:US
Mailing Address - Phone:440-338-6070
Mailing Address - Fax:
Practice Address - Street 1:34055 SOLON RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2662
Practice Address - Country:US
Practice Address - Phone:440-349-1400
Practice Address - Fax:440-349-0558
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH173461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice