Active NPI
Lacie Elizabeth Wilson Glick, RDH
- Dental Hygienist
- Gainesville, FL
National Provider Identifier
1053024604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 24315
- Practice address
- 3147 SW 45TH St Ste 40
Gainesville, FL 32608-2399 - Phone
- (352) 389-4386
- NPI assigned
- Dec 28, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 24315 | FL | Primary |
Addresses
Primary practice location
3147 SW 45TH St Ste 40
Gainesville, FL 32608-2399
Mailing address
1201 Mercer St Unit 405
Seattle, WA 98109-5780
Phone (352) 283-1535
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24315 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672185600000",
"number": "1053024604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 MERCER ST UNIT 405",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981095780",
"telephone_number": "352-283-1535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3147 SW 45TH ST STE 40",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326082399",
"telephone_number": "352-389-4386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICK",
"first_name": "LACIE",
"middle_name": "ELIZABETH WILSON",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-28",
"last_updated": "2022-12-28",
"certification_date": "2022-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "24315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.