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General NPI Number Information
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NPI Number | 1639831043
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Entity Type | Organization
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Legal Business Name | GLASSICK ORTHODONTICS, PC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 2202 NORTH BERKSHIRE ROAD STE 101
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901
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Country | US
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Telephone | 434-296-0188
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Fax | 540-426-2909
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Provider Business Mailing Address
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Address Line | 2202 NORTH BERKSHIRE ROAD STE 101
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901
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Country | US
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Telephone | 434-296-0188
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Fax | 540-426-2909
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW GLASSICK
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Credential | DDS
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Telephone | 434-296-0188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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