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NPI Code Detail

MEDICARE: DR. DAVID A. GLASS DDS

MEDICARE: DR. DAVID A. 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
11223G0001XGeneral Practice Dentistry0401008047VA

General Provider Information

NPI Number : 1962407775
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID A. GLASS DDS
Provider Business Mailing Address
First Line : 4613 CASPER CT
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-4601
Country : US
Telephone Number : 757-495-1692
Fax Number :
Provider Business Practice Location Address
First Line : 1647 ADMIRAL TAUSSIG BLVD
Second Line : NAVAL DENTAL CLINIC
City : NORFOLK
State : VA
Zip : 23511-2803
Country : US
Telephone Number : 757-314-6546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 07/08/2007

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