Organization
GLADE DENTAL PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN GINOYA (MANAGER)
(410) 833-8380
Entity
Organization
Contact information
Practice address
11710 REISTERSTOWN RD, 201, REISTERSTOWN, MD 21136-3363
(410) 833-8380
Mailing address
11710 REISTERSTOWN RD, 201, REISTERSTOWN, MD 21136-3363
(410) 833-8380
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
16179
MD
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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