Provider Demographics
NPI:1114023231
Name:GLASA, JAMES G (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:GLASA
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 1:3901 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1577
Mailing Address - Country:US
Mailing Address - Phone:505-888-7545
Mailing Address - Fax:505-888-7670
Practice Address - Street 1:3901 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1577
Practice Address - Country:US
Practice Address - Phone:505-888-7545
Practice Address - Fax:505-888-7670
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice