| Full Name | Glad Dental P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 293 E 149th St, Bronx, New York |
| Authorized Official Name and Position | Lia Datikashvili (PRESIDENT) |
| Authorized Official Contact | 6464045005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glad Dental P.c. 293 E 149th St Bronx NY 10451-5601 Ph: (646) 404-5005 | Glad Dental P.c. 293 E 149th St Bronx NY 10451-5601 Ph: (646) 404-5005 |
| NPI Number | 1548558836 |
|---|---|
| Provider Enumeration Date | 07/20/2011 |
| Last Update Date | 07/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548558836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 055422-1 (New York) | Primary |
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