Individual
DR. MARCELLUS GLADNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1209 BONITA ST, GRANTS, NM 87020-2103
(505) 876-4034
(505) 876-4036
Mailing address
1905 BLUE SPRUCE DR, GRANTS, NM 87020-4213
(505) 876-1065
(505) 876-4036
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DD1966
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8615
—
NM
05
—
Z9089
—
NM
Enumeration date
11/02/2005
Last updated
07/09/2007
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