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General NPI Number Information
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NPI Number | 1316564271
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Entity Type | Individual
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Provider Name | ZACHARY DAVID GLAUS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 1601 12TH AVE RD STE 103
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City | NAMPA
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State | ID
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Zip | 83686-6185
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Country | US
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Telephone | 208-467-9690
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Fax |
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Provider Business Mailing Address
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Address Line | 1184 W COASTAL DR
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City | MERIDIAN
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State | ID
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Zip | 83642-5286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-5168
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License Number State | ID
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