Individual provider Active NPI

William George Glecos, DDS

  • General Practice Dentistry
  • Erie, PA
National Provider Identifier
1174675219
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS018800L Issued in PA
Practice address
3408 State St
Erie, PA 16508-2832
Phone
(814) 459-1608
Fax
(814) 456-2832
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 DS018800L PA Primary

Addresses

Primary practice location

3408 State St
Erie, PA 16508-2832

Mailing address

3408 State St
Erie, PA 16508-2832
Phone (814) 459-1608

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20150630000509 PA Order and Referring Only - DentistPractitioner - Dentist 0042522377

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS018800LPAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174675219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3408 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082832",
            "telephone_number": "814-459-1608",
            "fax_number": "814-456-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082832",
            "telephone_number": "814-459-1608",
            "fax_number": "814-456-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLECOS",
        "first_name": "WILLIAM",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS018800L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.