Provider Demographics
NPI:1891322558
Name:CORE ENDODONTICS
Entity Type:Organization
Organization Name:CORE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GLEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-590-1514
Mailing Address - Street 1:2206 STATE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4952
Mailing Address - Country:US
Mailing Address - Phone:812-590-1514
Mailing Address - Fax:
Practice Address - Street 1:2206 STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4952
Practice Address - Country:US
Practice Address - Phone:812-590-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty