Provider Demographics
NPI:1548385677
Name:GLASS, BEVERLY MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:MARIE
Last Name:GLASS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 S SALISBURY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7127
Mailing Address - Country:US
Mailing Address - Phone:410-749-6545
Mailing Address - Fax:410-749-1718
Practice Address - Street 1:1410 S SALISBURY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7127
Practice Address - Country:US
Practice Address - Phone:410-749-6545
Practice Address - Fax:410-749-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics