Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | #DS-019337-L | PA |
NPI | 1043213697 |
---|---|
Provider Name | Dr. Joel Micheal Glickman |
First Address | Allentown, PA 18103 |
Second Address | Allentown, PA 18103-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#DS-019337-L | DENTAL LICENSE (01) | PA |