Provider Demographics
NPI:1497522627
Name:GLASS, KAYLA MARIA (RDH)
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:MARIA
Last Name:GLASS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S GROVE ST APT 108
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5671
Mailing Address - Country:US
Mailing Address - Phone:734-833-4936
Mailing Address - Fax:
Practice Address - Street 1:209 S GROVE ST APT 108
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5671
Practice Address - Country:US
Practice Address - Phone:734-833-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902020243124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist