Provider Demographics
NPI:1063563294
Name:THOMAS-GLAVIN, HOPE DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:HOPE
Middle Name:DIANE
Last Name:THOMAS-GLAVIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 LIMESTONE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1252
Mailing Address - Country:US
Mailing Address - Phone:302-239-6677
Mailing Address - Fax:302-239-8222
Practice Address - Street 1:5317 LIMESTONE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1252
Practice Address - Country:US
Practice Address - Phone:302-239-6677
Practice Address - Fax:302-239-8222
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00010021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000962608Medicaid