Provider Demographics
NPI:1952044596
Name:COUNCILL AND GLASS DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:COUNCILL AND GLASS DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-376-9246
Mailing Address - Street 1:10924 GRANT RD # 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4445
Mailing Address - Country:US
Mailing Address - Phone:281-376-9246
Mailing Address - Fax:281-370-8398
Practice Address - Street 1:12835 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5207
Practice Address - Country:US
Practice Address - Phone:281-376-9246
Practice Address - Fax:281-370-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty