Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7552 | MD |
NPI | 1710008933 |
---|---|
Provider Name | Dr. John Vernon Gladden |
First Address | Laurel, MD 20723-5992 |
Second Address | Randallstown, MD 21133-4733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7552 | STATE DENTAL LICENSE NO. (01) | MD |