Provider Demographics
NPI:1528412988
Name:SHIRA GLAZER
Entity Type:Organization
Organization Name:SHIRA GLAZER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-319-8486
Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:STE. 312
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:504-319-8486
Mailing Address - Fax:
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:STE. 312
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3500
Practice Address - Country:US
Practice Address - Phone:504-319-8486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6636261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental