| NPI | 1649543190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN H GLASS Owner 251-626-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AL 5046) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |