MEDICARE: ROBERT C GLUECK DDS INC

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	1223G0001X	General Practice Dentistry	13281	OH

General Provider Information

NPI Number	:	1922101146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT C GLUECK DDS INC

Provider Business Mailing Address
First Line	:	2752 ERIE AVENUE
Second Line	:	SUITE 10
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2207
Country	:	US
Telephone Number	:	513-871-4411
Fax Number	:	513-871-4411

Provider Business Practice Location Address
First Line	:	2752 ERIE AVENUE
Second Line	:	SUITE 10
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2207
Country	:	US
Telephone Number	:	513-871-4411
Fax Number	:	513-871-4411

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT CHARLES GLUECK
Credential	:	DDS
Telephone Number	:	513-871-4411

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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