Active NPI
Michael Glick, D.M.D
- Dentist
- Mesa, AZ
National Provider Identifier
1609897032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02154000
- Practice address
- 5850 E Still Cir
Mesa, AZ 85206-3618 - Phone
- (480) 219-6103
- Fax
- (480) 219-6102
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02154000 | NJ | Primary |
Addresses
Primary practice location
5850 E Still Cir
Mesa, AZ 85206-3618
Mailing address
4621 E Palo Verde Dr
Phoenix, AZ 85018-1258
Phone (480) 219-6103
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 |
|---|---|---|---|
| 22DI02154000 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609897032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4621 E PALO VERDE DR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850181258",
"telephone_number": "480-219-6103",
"fax_number": "480-219-6102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5850 E STILL CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852063618",
"telephone_number": "480-219-6103",
"fax_number": "480-219-6102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICK",
"first_name": "MICHAEL",
"name_prefix": "Prof.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02154000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.