1710900204 NPI number — DR. MARK GLADNICK D.D.S.

Table of content: DR. MARK GLADNICK D.D.S. (NPI 1710900204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710900204 NPI number — DR. MARK GLADNICK D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLADNICK
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1710900204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5513 KIRKWOOD HWY
Provider Second Line Business Mailing Address:
KIRKWOOD-MILLTOWN PROFESSIONAL PLAZA
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-994-2660
Provider Business Mailing Address Fax Number:
302-994-6237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5513 KIRKWOOD HWY
Provider Second Line Business Practice Location Address:
KIRKWOOD-MILLTOWN PROFESSIONAL PLAZA
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-994-2660
Provider Business Practice Location Address Fax Number:
302-994-6237
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  G10000889 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000883108 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com