Healthcare Provider Details

I. General information

NPI: 1871601120
Provider Name (Legal Business Name): GEORGE JEFFREY GLIKES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 1/2 GEORGE ST
GREEN ISLAND NY
12183-1115
US

IV. Provider business mailing address

97 1/2 GEORGE ST
GREEN ISLAND NY
12183-1115
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-7732
  • Fax: 518-272-2322
Mailing address:
  • Phone: 518-272-7732
  • Fax: 518-272-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0394861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: