Provider Demographics
NPI:1679670285
Name:GLASS, ANTHONY ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ALEXANDER
Last Name:GLASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 W HWY 276
Mailing Address - Street 2:
Mailing Address - City:WEST TAWAKONI
Mailing Address - State:TX
Mailing Address - Zip Code:75474-6467
Mailing Address - Country:US
Mailing Address - Phone:903-447-3206
Mailing Address - Fax:903-447-2988
Practice Address - Street 1:945 W HWY 276
Practice Address - Street 2:
Practice Address - City:WEST TAWAKONI
Practice Address - State:TX
Practice Address - Zip Code:75474-6467
Practice Address - Country:US
Practice Address - Phone:903-447-3206
Practice Address - Fax:903-447-2988
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice