Provider Demographics
NPI:1891300026
Name:ALEKSANDRA GLODEK DMD PC
Entity Type:Organization
Organization Name:ALEKSANDRA GLODEK DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLODEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-362-4994
Mailing Address - Street 1:221 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2232
Mailing Address - Country:US
Mailing Address - Phone:847-362-4994
Mailing Address - Fax:
Practice Address - Street 1:221 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2232
Practice Address - Country:US
Practice Address - Phone:847-362-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty