Healthcare Provider Details

I. General information

NPI: 1962812305
Provider Name (Legal Business Name): SARAH H GLASS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NORTH 12TH STREET SUITE 315
RICHMOND VA
23298
US

IV. Provider business mailing address

520 NORTH 12TH STREET SUITE 215
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-1778
  • Fax: 804-628-2001
Mailing address:
  • Phone: 804-828-1778
  • Fax: 804-628-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number0401415451
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: