Provider Demographics
NPI:1053791236
Name:WALTER L. GLASS, D.D.S., P.C.
Entity type:Organization
Organization Name:WALTER L. GLASS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-979-4981
Mailing Address - Street 1:7325 S PIERCE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4553
Mailing Address - Country:US
Mailing Address - Phone:303-979-4981
Mailing Address - Fax:
Practice Address - Street 1:7325 S PIERCE ST STE 201
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4553
Practice Address - Country:US
Practice Address - Phone:303-979-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1861508723OtherNPI TYPE 1