Healthcare Provider Details

I. General information

NPI: 1891322558
Provider Name (Legal Business Name): CORE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 STATE ST STE 100
NEW ALBANY IN
47150-4952
US

IV. Provider business mailing address

2206 STATE ST STE 100
NEW ALBANY IN
47150-4952
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-1514
  • Fax:
Mailing address:
  • Phone: 812-590-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CARMEL P GLEIS
Title or Position: OWNER
Credential:
Phone: 812-590-1514