Provider Demographics
NPI:1538301460
Name:NELSON D. GLASSETT LLC
Entity Type:Organization
Organization Name:NELSON D. GLASSETT LLC
Other - Org Name:GLASSETT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-619-8664
Mailing Address - Street 1:11576 S STATE ST
Mailing Address - Street 2:SUITE 1203
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6431
Mailing Address - Country:US
Mailing Address - Phone:801-619-8664
Mailing Address - Fax:801-619-8787
Practice Address - Street 1:11576 S STATE ST
Practice Address - Street 2:SUITE 1203
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6431
Practice Address - Country:US
Practice Address - Phone:801-619-8664
Practice Address - Fax:801-619-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty