Healthcare Provider Details

I. General information

NPI: 1932202454
Provider Name (Legal Business Name): JAMES GLINATSIS DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27155 CHARDON RD SUITE 105
RICHMOND HTS OH
44143-1183
US

IV. Provider business mailing address

27155 CHARDON RD SUITE 105
RICHMOND HTS OH
44143-1183
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-4327
  • Fax: 440-944-6358
Mailing address:
  • Phone: 440-944-4327
  • Fax: 440-944-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19254
License Number StateOH

VIII. Authorized Official

Name: MR. JAMES GLINATSIS
Title or Position: DENTIST
Credential: DDS
Phone: 440-944-4327