Individual provider Active NPI

Mark Gladnick, D.D.S.

  • Dentist
  • Wilmington, DE
National Provider Identifier
1710900204
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
G10000889 Issued in DE
Practice address
5513 Kirkwood Hwy
Kirkwood-Milltown Professional Plaza
Wilmington, DE 19808-5001
Phone
(302) 994-2660
Fax
(302) 994-6237
NPI assigned
Jul 25, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X G10000889 DE Primary

Addresses

Primary practice location

5513 Kirkwood Hwy
Kirkwood-Milltown Professional Plaza
Wilmington, DE 19808-5001

Mailing address

5513 Kirkwood Hwy
Kirkwood-Milltown Professional Plaza
Wilmington, DE 19808-5001
Phone (302) 994-2660

Other identifiers 1

IdentifierTypeStateIssuer
0000883108MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20150701000919 DE Order and Referring Only - DentistPractitioner - Dentist 5395057533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
G10000889DEMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Delaware Dental, P.a. PastSince Oct 6, 2024 Accepting new patients

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1710900204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5513 KIRKWOOD HWY",
            "address_2": "KIRKWOOD-MILLTOWN PROFESSIONAL PLAZA",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198085001",
            "telephone_number": "302-994-2660",
            "fax_number": "302-994-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5513 KIRKWOOD HWY",
            "address_2": "KIRKWOOD-MILLTOWN PROFESSIONAL PLAZA",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198085001",
            "telephone_number": "302-994-2660",
            "fax_number": "302-994-6237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLADNICK",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DE",
            "license": "G10000889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000883108",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.