Provider Demographics
NPI:1043323140
Name:GLADD, BILL N/A (DDS)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:N/A
Last Name:GLADD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1975
Mailing Address - Country:US
Mailing Address - Phone:580-225-4436
Mailing Address - Fax:580-225-6846
Practice Address - Street 1:1011 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2830
Practice Address - Country:US
Practice Address - Phone:580-225-4436
Practice Address - Fax:580-225-6846
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73-12565771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice