MEDICARE: GLEN R. GINTER, DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10046	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295993244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN R. GINTER, DDS, INC.

Provider Business Mailing Address
First Line	:	21830 KINGSLAND BLVD
Second Line	:	STE 104
City	:	KATY
State	:	TX
Zip	:	77450-2517
Country	:	US
Telephone Number	:	281-578-7100
Fax Number	:	281-398-8817

Provider Business Practice Location Address
First Line	:	21830 KINGSLAND BLVD
Second Line	:	STE104
City	:	KATY
State	:	TX
Zip	:	77450-2517
Country	:	US
Telephone Number	:	281-578-7100
Fax Number	:	281-398-8817

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLEN ROBERT GINTER
Credential	:	DDS
Telephone Number	:	281-578-7100

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	10/19/2011

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