Provider Demographics
NPI:1104168012
Name:GLASS, THOMAS W (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:GLASS
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BROOKES AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2901
Mailing Address - Country:US
Mailing Address - Phone:301-948-2728
Mailing Address - Fax:
Practice Address - Street 1:201 BROOKES AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2901
Practice Address - Country:US
Practice Address - Phone:301-948-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist