Healthcare Provider Details

I. General information

NPI: 1538167754
Provider Name (Legal Business Name): GLICKSMAN, MARS DENTAL , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 NE 207TH ST STE 100
AVENTURA FL
33180-1471
US

IV. Provider business mailing address

2797 NE 207TH ST STE 100
AVENTURA FL
33180-1471
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-2797
  • Fax: 305-937-4834
Mailing address:
  • Phone: 305-935-2797
  • Fax: 305-937-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN11641
License Number StateFL

VIII. Authorized Official

Name: DR. RICK A MARS
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 305-935-2797