Provider Demographics
NPI:1245917293
Name:GLASS, NATASHA KAYE (DA)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:KAYE
Last Name:GLASS
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-0626
Mailing Address - Country:US
Mailing Address - Phone:918-508-5372
Mailing Address - Fax:
Practice Address - Street 1:8921 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5841
Practice Address - Country:US
Practice Address - Phone:888-397-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDA15460126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant