Healthcare Provider Details

I. General information

NPI: 1700894193
Provider Name (Legal Business Name): PAUL GLASSMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CORTE DE SABLA
GREENBRAE CA
94904-1310
US

IV. Provider business mailing address

70 CORTE DE SABLA
GREENBRAE CA
94904-1310
US

V. Phone/Fax

Practice location:
  • Phone: 415-713-5178
  • Fax: 415-713-5178
Mailing address:
  • Phone: 415-713-5178
  • Fax: 415-713-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCA22886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: