MEDICARE: DR. JOSEPH ISRAEL GLIKSMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8727	NC

General Provider Information

NPI Number	:	1366412512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ISRAEL GLIKSMAN D.D.S.

Provider Business Mailing Address
First Line	:	50 OFFICE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-3217
Country	:	US
Telephone Number	:	910-347-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 OFFICE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-3217
Country	:	US
Telephone Number	:	910-347-5151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	04/24/2017

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