Stephen Eric Glick, D.D.S.
Individual provider Active NPI General Practice Dentistry · Manakin Sabot, VA
NPI 1669495693 · NPPES record last updated Jul 29, 2011
Key facts
- NPI
- 1669495693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 401410243 (VA)
- Practice address
- 1600 Hockett Rd
Manakin Sabot, VA 23103-2229 - Phone
- (804) 784-4150
- Fax
- (804) 784-1232
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150322000010 | VA | Order and Referring Only - Dentist |
6901123413 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN15156 | FL | MD | General Practice Dentistry |
| 401410243 | VA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephen E Glick DDS PC | General Practice | Past | Accepting new patients |
| Stephen E. Glick, DDS, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 401410243 | VA | Yes |
| General Practice Dentistry | 1223G0001X | DN15156 | FL |
Addresses
Primary practice location
1600 Hockett Rd
Manakin Sabot, VA 23103-2229
Mailing address
1600 Hockett Rd
Manakin Sabot, VA 23103-2229
Phone (804) 784-4150
Other providers in Manakin Sabot, VA
- William Ervin I
- Family Care Services, LLC
- Family Chiropractic Center of Richmond, LLC
- Linda Fletcher
- Nicole Jeanette Galletta
- Berta Lisbeth Granados Ortega
- Heidi Ellen Greene
- Elizabeth G Hall
- Meisha Harris
- Paula Harrison
All providers in Manakin Sabot, VA · General Practice Dentistry in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.