Provider Demographics
NPI:1811169014
Name:PAUL LYLE GLASSER DDS, PC
Entity type:Organization
Organization Name:PAUL LYLE GLASSER DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-981-4900
Mailing Address - Street 1:5243 SNAPFINGER WOODS DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4000
Mailing Address - Country:US
Mailing Address - Phone:770-981-4900
Mailing Address - Fax:770-981-4901
Practice Address - Street 1:5243 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE 107
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4000
Practice Address - Country:US
Practice Address - Phone:770-981-4900
Practice Address - Fax:770-981-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN007870261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental