Provider Demographics
NPI:1881815538
Name:GLACKIN, AIDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AIDAN
Middle Name:
Last Name:GLACKIN
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 1:124 MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6922
Mailing Address - Country:US
Mailing Address - Phone:631-421-4131
Mailing Address - Fax:631-421-1456
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-421-4131
Practice Address - Fax:631-421-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0441131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice