Individual
LINDA ANN GLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.D.A. EFDA
Contact information
Practice address
5047 VIRGINIA AVE., FORT LEONARD WOOD, MO 65473-1317
(573) 596-0408
(573) 596-0314
Mailing address
5047 VIRGINIA AVE., HARPER DENTAL CLINIC BLD 500, FORT LEONARD WOOD, MO 65473-1317
(573) 596-0408
(573) 596-0314
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
2013015015
MO
126800000X
Dental Assistant
2013015016
MO
126800000X
Dental Assistant
2013015017
MO
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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