Provider Demographics
NPI:1245507870
Name:GLASER DENTAL
Entity type:Organization
Organization Name:GLASER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-359-4344
Mailing Address - Street 1:24 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROTHSCHILD
Mailing Address - State:WI
Mailing Address - Zip Code:54474-1111
Mailing Address - Country:US
Mailing Address - Phone:715-359-4344
Mailing Address - Fax:715-359-7733
Practice Address - Street 1:24 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474-1111
Practice Address - Country:US
Practice Address - Phone:715-359-4344
Practice Address - Fax:715-359-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5071-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty