Provider Demographics
NPI:1326376567
Name:EUGENE H. GLAD D.M.D. P.A.
Entity type:Organization
Organization Name:EUGENE H. GLAD D.M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:GLAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-622-1430
Mailing Address - Street 1:11 MIDDLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5210
Mailing Address - Country:US
Mailing Address - Phone:207-622-1430
Mailing Address - Fax:
Practice Address - Street 1:11 MIDDLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5210
Practice Address - Country:US
Practice Address - Phone:207-622-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN28701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME123710000Medicaid