1548376379 NPI number — VA NORTH TEXAS HEALTH CARE SYSTEM

Table of content: DR. STEVEN ROBERT GLUCK D.D.S. (NPI 1861513707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548376379 NPI number — VA NORTH TEXAS HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VA NORTH TEXAS HEALTH CARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548376379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 S. LANCASTER RD
Provider Second Line Business Mailing Address:
DALLAS VA MEDICAL CENTER, APMS(112A)
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-857-1818
Provider Business Mailing Address Fax Number:
214-857-1867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 S. LANCASTER RD
Provider Second Line Business Practice Location Address:
DALLAS VA MEDICAL CENTER, APMS(112A)
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-857-1818
Provider Business Practice Location Address Fax Number:
214-857-1867
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
SYED
Authorized Official Middle Name:
ADIL
Authorized Official Title or Position:
STAFF ANESTHESIOLOGIST
Authorized Official Telephone Number:
214-857-1818

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , with the licence number:  156738 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)