=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518192160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH STEVEN GLUSKI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2009
-----------------------------------------------------
Last Update Date | 05/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 25TH ST
-----------------------------------------------------
City | GALVESTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77550-4407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-765-9190
-----------------------------------------------------
Fax | 409-766-1825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 25TH ST
-----------------------------------------------------
City | GALVESTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77550-4407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-765-9190
-----------------------------------------------------
Fax | 409-766-1825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 17479
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------