Healthcare Provider Details

I. General information

NPI: 1326376567
Provider Name (Legal Business Name): EUGENE H. GLAD D.M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MIDDLE ST SUITE 1
AUGUSTA ME
04330-5210
US

IV. Provider business mailing address

11 MIDDLE ST SUITE 1
AUGUSTA ME
04330-5210
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1430
  • Fax:
Mailing address:
  • Phone: 207-622-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN2870
License Number StateME

VIII. Authorized Official

Name: DR. EUGENE HARRISON GLAD
Title or Position: ORTHODONTIST
Credential: D.M.D.
Phone: 207-622-1430