Provider Demographics
NPI:1811094824
Name:GLASS, NEIL MORGAN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:MORGAN
Last Name:GLASS
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:18916 SADDLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4102
Mailing Address - Country:US
Mailing Address - Phone:405-341-0079
Mailing Address - Fax:405-755-9096
Practice Address - Street 1:4320 MCAULEY BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8364
Practice Address - Country:US
Practice Address - Phone:405-755-4826
Practice Address - Fax:405-755-9096
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OK34621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT79944Medicare UPIN