Provider Demographics
NPI:1740212711
Name:GLASS, LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:GLASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:GLASS DDS INC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3133 SHADY RUN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2841
Mailing Address - Country:US
Mailing Address - Phone:330-788-2212
Mailing Address - Fax:330-781-0000
Practice Address - Street 1:3133 SHADY RUN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2841
Practice Address - Country:US
Practice Address - Phone:330-788-2212
Practice Address - Fax:330-781-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist