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General NPI Number Information
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NPI Number | 1649543190
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Entity Type | Organization
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Legal Business Name | GLENN H GLASS DMD MS PC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1303 MAIN ST
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City | DAPHNE
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State | AL
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Zip | 36526-4422
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Country | US
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Telephone | 251-626-7770
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Fax | 251-626-7464
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Provider Business Mailing Address
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Address Line | PO BOX 2465
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City | DAPHNE
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State | AL
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Zip | 36526-2465
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Country | US
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Telephone | 251-626-7770
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Fax | 251-626-7464
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN H GLASS
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Credential |
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Telephone | 251-626-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 5046
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License Number State | AL
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