MEDICARE: DR. MARCELLA AMANDA GLEASON D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9582	KY
2	122300000X	Dentist	9582	KY
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467833194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELLA AMANDA GLEASON D.M.D.

Provider Business Mailing Address
First Line	:	155 BETH CT
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-8596
Country	:	US
Telephone Number	:	270-317-4149
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 LEITCHFIELD RD
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-3281
Country	:	US
Telephone Number	:	317-442-9757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	03/05/2026

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