Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401005115 | VA |
N | 124Q00000X | Dental Hygienist | 0402203393 | VA |
N | 126800000X | Dental Assistant |
NPI | 1205845021 |
---|---|
Provider Name | James O Glaser |
First Address | Chesterfield, VA 23832 |
Second Address | Chesterfield, VA 23832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |