MEDICARE: TATUM LAYNE GLASER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	62367	KS

General Provider Information

NPI Number	:	1205789112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATUM LAYNE GLASER DDS

Provider Business Mailing Address
First Line	:	1205 SE 10TH STREET TER
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-7512
Country	:	US
Telephone Number	:	913-205-4724
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 MELVIN ST
Second Line	:
City	:	MARION
State	:	KS
Zip	:	66861-1235
Country	:	US
Telephone Number	:	620-382-2520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	06/09/2026

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