MEDICARE: DR. PAUL LYLE GLASSER 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	1223P0221X	Pediatric Dentistry	7870	GA

General Provider Information

NPI Number	:	1881686269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL LYLE GLASSER DDS

Provider Business Mailing Address
First Line	:	5243 SNAPFINGER WOODS DR
Second Line	:	SUITE 107
City	:	DECATUR
State	:	GA
Zip	:	30035-4000
Country	:	US
Telephone Number	:	770-981-4900
Fax Number	:	678-418-1113

Provider Business Practice Location Address
First Line	:	5243 SNAPFINGER WOODS DR
Second Line	:	SUITE 107
City	:	DECATUR
State	:	GA
Zip	:	30035-4000
Country	:	US
Telephone Number	:	770-981-4900
Fax Number	:	678-418-1113

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	12/03/2013

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