Provider Demographics
NPI:1174789440
Name:GLUCK, KENNETH A (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:GLUCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 BERGEN ST
Mailing Address - Street 2:ROOM C-781
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-4214
Mailing Address - Fax:973-972-3884
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:ROOM C-781
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-4214
Practice Address - Fax:973-972-3884
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023796001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics