Provider Demographics
NPI:1033253661
Name:GLAZER, JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:GLAZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-2116
Mailing Address - Country:US
Mailing Address - Phone:860-349-3368
Mailing Address - Fax:
Practice Address - Street 1:16 MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-2116
Practice Address - Country:US
Practice Address - Phone:860-712-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300223061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice