Provider Demographics
NPI:1033573332
Name:NASER, GLENN EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:EDWARD
Last Name:NASER
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 1:1525 N FRONT ST UNIT 603
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2571
Mailing Address - Country:US
Mailing Address - Phone:717-991-7788
Mailing Address - Fax:
Practice Address - Street 1:1 HACC DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2903
Practice Address - Country:US
Practice Address - Phone:717-780-2240
Practice Address - Fax:717-780-1170
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020645L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist