Provider Demographics
NPI:1831548106
Name:GLIWA, CHRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GLIWA
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 1:6415 W TILLEN RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:NY
Mailing Address - Zip Code:14025-9796
Mailing Address - Country:US
Mailing Address - Phone:716-941-6848
Mailing Address - Fax:
Practice Address - Street 1:210 E TRADE ST STE E484
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2672
Practice Address - Country:US
Practice Address - Phone:704-632-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC106771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program