Provider Demographics
NPI:1205845021
Name:GLASER, JAMES O (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:O
Last Name:GLASER
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 1:9510 IRONBRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832
Mailing Address - Country:US
Mailing Address - Phone:804-768-7600
Mailing Address - Fax:804-768-0115
Practice Address - Street 1:9510 IRONBRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832
Practice Address - Country:US
Practice Address - Phone:804-768-7600
Practice Address - Fax:804-768-0115
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005115122300000X
VA0402203393124Q00000X
126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered124Q00000XDental ProvidersDental Hygienist
Not Answered126800000XDental ProvidersDental Assistant