Provider Demographics
NPI:1427063866
Name:GLEICHAUF, CARL ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ANTHONY
Last Name:GLEICHAUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NO 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638
Mailing Address - Country:US
Mailing Address - Phone:740-532-7811
Mailing Address - Fax:740-532-5912
Practice Address - Street 1:113 N 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1471
Practice Address - Country:US
Practice Address - Phone:740-532-7811
Practice Address - Fax:740-532-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300192461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0797928Medicaid