Provider Demographics
NPI:1437388873
Name:JASON R GLAZER DMD
Entity Type:Organization
Organization Name:JASON R GLAZER DMD
Other - Org Name:GLAZER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-349-3368
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:860-349-1481
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:860-349-3368
Practice Address - Fax:860-349-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0093541223G0001X
CT0098731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty