MEDICARE: DR. SHARIAN D GLAZE D.D.S.

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	1223G0001X	General Practice Dentistry	DEN1000568	DC
2	1223G0001X	General Practice Dentistry	12728	MD

General Provider Information

NPI Number	:	1730179326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARIAN D GLAZE D.D.S.

Provider Business Mailing Address
First Line	:	5018 E CAPITOL ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5326
Country	:	US
Telephone Number	:	202-388-7735
Fax Number	:	202-388-5202

Provider Business Practice Location Address
First Line	:	123 45TH ST NE
Second Line	:	DENTAL DEPT.
City	:	WASHINGTON
State	:	DC
Zip	:	20019-4632
Country	:	US
Telephone Number	:	202-388-7735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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