Provider Demographics
NPI:1013985910
Name:GLICK, PAUL L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:GLICK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 S TULARE CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4368
Mailing Address - Country:US
Mailing Address - Phone:303-880-8649
Mailing Address - Fax:
Practice Address - Street 1:23264 TWO RIVERS RD
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9251
Practice Address - Country:US
Practice Address - Phone:970-927-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1052111223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics