Healthcare Provider Details

I. General information

NPI: 1376789057
Provider Name (Legal Business Name): STEPHEN D GLASS DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 LOUETTA RD SUITE A
SPRING TX
77379-7456
US

IV. Provider business mailing address

7000 LOUETTA RD SUITE A
SPRING TX
77379-7456
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-1214
  • Fax: 281-257-2704
Mailing address:
  • Phone: 281-376-1214
  • Fax: 281-257-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number19852
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN D GLASS
Title or Position: OWNER
Credential: DDS
Phone: 281-376-1214