Provider Demographics
NPI:1720324288
Name:DR.MILTON A.GLICKSMAN AND DR.MARLY GOMES
Entity type:Organization
Organization Name:DR.MILTON A.GLICKSMAN AND DR.MARLY GOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLICKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-999-2234
Mailing Address - Street 1:49 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3322
Mailing Address - Country:US
Mailing Address - Phone:508-999-2234
Mailing Address - Fax:508-999-1155
Practice Address - Street 1:49 STATE RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3322
Practice Address - Country:US
Practice Address - Phone:508-999-2234
Practice Address - Fax:508-999-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty