1669579967 NPI number — DR. CARL GERHARDT GLASER DMD

Table of content: DR. CARL GERHARDT GLASER DMD (NPI 1669579967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669579967 NPI number — DR. CARL GERHARDT GLASER DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLASER
Provider First Name:
CARL
Provider Middle Name:
GERHARDT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669579967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
646 SWIFT RD
Provider Second Line Business Mailing Address:
UNITED STATES MILITARY ACADEMY DENTAC,
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10996-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-938-4212
Provider Business Mailing Address Fax Number:
845-938-4302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY
Provider Second Line Business Practice Location Address:
DENTAC, BLDG 606, 1ST FLOOR
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10996-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-938-4212
Provider Business Practice Location Address Fax Number:
845-938-4302
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22D101096100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)