MEDICARE: DR. WALTER LEE GLASS DDS

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	662	CO

General Provider Information

NPI Number	:	1861508723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER LEE GLASS DDS

Provider Business Mailing Address
First Line	:	7325 S PIERCE ST
Second Line	:	SUITE 201
City	:	LITTLETON
State	:	CO
Zip	:	80128-4553
Country	:	US
Telephone Number	:	303-979-4981
Fax Number	:	303-933-6937

Provider Business Practice Location Address
First Line	:	7325 S PIERCE ST
Second Line	:	SUITE 201
City	:	LITTLETON
State	:	CO
Zip	:	80128-4553
Country	:	US
Telephone Number	:	303-979-4981
Fax Number	:	303-933-6937

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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