Provider Demographics
NPI:1841692522
Name:GLADE DENTAL CLINIC
Entity type:Organization
Organization Name:GLADE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-628-9507
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:GLADE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24340-0638
Mailing Address - Country:US
Mailing Address - Phone:276-429-5111
Mailing Address - Fax:276-429-2888
Practice Address - Street 1:634 S MONTE VISTA DR
Practice Address - Street 2:
Practice Address - City:GLADE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24340-2712
Practice Address - Country:US
Practice Address - Phone:276-429-5111
Practice Address - Fax:276-429-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty