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General NPI Number Information
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NPI Number | 1619001609
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Entity Type | Individual
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Provider Name | GLEN ALFRED MAGYERA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3216 BUSINESS PARK DRIVE
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City | STEVENS POINT
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State | WI
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Zip | 54481
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Country | US
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Telephone | 715-341-7171
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Fax | 715-341-5160
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Provider Business Mailing Address
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Address Line | 3216 BUSINESS PARK DR
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City | STEVENS POINT
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State | WI
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Zip | 54481-8838
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Country | US
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Telephone | 715-341-7171
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Fax | 715-341-5160
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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 | WI2735
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License Number State | WI
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