Provider Demographics
NPI:1366322877
Name:PG DENTAL LLC
Entity type:Organization
Organization Name:PG DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-265-1155
Mailing Address - Street 1:350 MAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9219
Mailing Address - Country:US
Mailing Address - Phone:973-265-1155
Mailing Address - Fax:973-917-3506
Practice Address - Street 1:350 MAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9219
Practice Address - Country:US
Practice Address - Phone:973-265-1155
Practice Address - Fax:973-917-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty