Provider Demographics
NPI:1285855601
Name:JAN M. PIPER-GLASGOW, DMD PC
Entity Type:Organization
Organization Name:JAN M. PIPER-GLASGOW, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PIPER-GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-586-3990
Mailing Address - Street 1:40 GROVE ST # B
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1317
Mailing Address - Country:US
Mailing Address - Phone:585-586-3990
Mailing Address - Fax:585-586-4389
Practice Address - Street 1:40 GROVE ST # B
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1317
Practice Address - Country:US
Practice Address - Phone:585-586-3990
Practice Address - Fax:585-586-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036963-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00491350Medicaid