Individual provider Active NPI

Glenn Boris Shtarkman, D.M.D

  • General Practice Dentistry
  • Parma Heights, OH
National Provider Identifier
1023161403
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30-022124 Issued in OH
Practice address
6363 York Rd Ste 203
Parma Heights, OH 44130-3031
Phone
(440) 885-5354
NPI assigned
Jan 19, 2007
Last updated
Nov 13, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30-022124 OH Primary

Addresses

Primary practice location

6363 York Rd Ste 203
Parma Heights, OH 44130-3031

Mailing address

6363 York Rd Ste 203
Parma Heights, OH 44130-3031
Phone (440) 885-5354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170127001458 OH Order and Referring Only - DentistPractitioner - Dentist 6406138411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30-022124OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Glenn Shtarkman DMD LLC General Practice CurrentSince Nov 18, 2025 Accepting new patients

Locations

6363 York Rd
Ste 203
Parma Heights, OH 44130
Phone (440) 885-5354

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762992000000",
    "number": "1023161403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 YORK RD STE 203",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441303031",
            "telephone_number": "440-885-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 YORK RD STE 203",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441303031",
            "telephone_number": "440-885-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHTARKMAN",
        "first_name": "GLENN",
        "middle_name": "BORIS",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-022124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parma Heights, OH

Sources for this page

Verify at the official NPI Registry.