=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033573332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN EDWARD NASER D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2016
-----------------------------------------------------
Last Update Date | 04/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HACC DR
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17110-2903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-780-2240
-----------------------------------------------------
Fax | 717-780-1170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 N FRONT ST UNIT 603
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17102-2571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-991-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS020645L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------