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General NPI Number Information
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NPI Number | 1487973343
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Entity Type | Individual
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Provider Name | JONATHAN RHODES GLASS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 12835 LOUETTA RD
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City | CYPRESS
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State | TX
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Zip | 77429-5207
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Country | US
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Telephone | 281-376-9246
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Fax |
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Provider Business Mailing Address
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Address Line | 12835 LOUETTA RD
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City | CYPRESS
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State | TX
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Zip | 77429-5207
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Country | US
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Telephone | 281-376-9246
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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 | 28492
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License Number State | TX
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