Provider Demographics
NPI:1932485273
Name:GLEICH, CAROLE ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANNE
Last Name:GLEICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-1540
Mailing Address - Country:US
Mailing Address - Phone:319-400-0607
Mailing Address - Fax:
Practice Address - Street 1:5321 W 151ST ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-9637
Practice Address - Country:US
Practice Address - Phone:913-851-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088511223G0001X
OK63501223G0001X
MO20130434331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice