Provider Demographics
NPI:1033621339
Name:DR. GRANT GLAUSER DDS PLLC
Entity Type:Organization
Organization Name:DR. GRANT GLAUSER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-983-8583
Mailing Address - Street 1:11400 TIBEE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1925
Mailing Address - Country:US
Mailing Address - Phone:512-983-8583
Mailing Address - Fax:
Practice Address - Street 1:12401 HYMEADOW DR
Practice Address - Street 2:BLDG 5
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750
Practice Address - Country:US
Practice Address - Phone:512-250-8225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29080261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental