Paul L Glick, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

105211 Issued in CO

Practice address

23264 Two Rivers Rd
Basalt, CO 81621-9251

Phone

(970) 927-3776

NPI assigned

Mar 8, 2006

Last updated

Nov 19, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 4, 2012 through May 4, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David N Fishman DDS PC

  • Dentist
  • Basalt, CO
  • NPI 1164436580
  NPD (past)
• Periodontal Associates

  • Periodontics
  • Aurora, CO
  • NPI 1801863303
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1013985910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3366 S TULARE CT",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802314368",
            "telephone_number": "303-880-8649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23264 TWO RIVERS RD",
            "city": "BASALT",
            "state": "CO",
            "postal_code": "816219251",
            "telephone_number": "970-927-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "PAUL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "105211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Franklin, PHARMD
• James Russell Fraser III, D.C
• Kristine Gatdula, RDH
• Laura A Geddes, LPC
• Stanley Gertzbein, M.D.
• Stephanie Rose Gorman, MSW, SWC
• Growth Early Childhood Behavior Consulting (Growth Early Childhood Behavior Coaching)
• Jonathan James Haerter, DDS
• Haley Yost - Pediatric PT LLC
• Amy Halstead, PMHNP

• Periodontics in Basalt, CO
• Providers in Basalt, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.