Provider Demographics
NPI:1063424547
Name:GLASS, STEPHEN DEWAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DEWAYNE
Last Name:GLASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 LOUETTA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7456
Mailing Address - Country:US
Mailing Address - Phone:281-376-1214
Mailing Address - Fax:281-257-2704
Practice Address - Street 1:7000 LOUETTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7456
Practice Address - Country:US
Practice Address - Phone:281-376-1214
Practice Address - Fax:281-257-2704
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198521223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice