Provider Demographics
NPI:1780753293
Name:C. FRED GLAZENER, D.D.S., INC
Entity type:Organization
Organization Name:C. FRED GLAZENER, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:GLAZENER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-776-3535
Mailing Address - Street 1:2681 STATE HIGHWAY 361
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-4200
Mailing Address - Country:US
Mailing Address - Phone:361-776-3535
Mailing Address - Fax:866-766-2629
Practice Address - Street 1:2681 STATE HIGHWAY 361
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-4200
Practice Address - Country:US
Practice Address - Phone:361-776-3535
Practice Address - Fax:866-766-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER