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General NPI Number Information
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NPI Number | 1518042266
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Entity Type | Individual
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Provider Name | JASON SCOTT GLICK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 2942 CENTRAL ST
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City | EVANSTON
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State | IL
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Zip | 60201-1246
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Country | US
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Telephone | 847-905-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 CENTRAL ST
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City | EVANSTON
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State | IL
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Zip | 60201-1246
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Country | US
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Telephone | 847-905-0555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021.002285
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | FAC-40237
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002285
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License Number State | IL
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