Provider Demographics
NPI:1740325844
Name:GLIKSBERG, JEROME (DDS)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:GLIKSBERG
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 1:22 RT 10 WEST
Mailing Address - Street 2:STE 102
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-598-1600
Mailing Address - Fax:973-598-1618
Practice Address - Street 1:22 RT 10 WEST
Practice Address - Street 2:STE 102
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-598-1600
Practice Address - Fax:973-598-1618
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics