Provider Demographics
NPI:1285037739
Name:SHARON NEW GLASS D.M.D LLC
Entity type:Organization
Organization Name:SHARON NEW GLASS D.M.D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-755-1111
Mailing Address - Street 1:105 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2331
Mailing Address - Country:US
Mailing Address - Phone:205-755-1111
Mailing Address - Fax:205-755-8448
Practice Address - Street 1:105 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2331
Practice Address - Country:US
Practice Address - Phone:205-755-1111
Practice Address - Fax:205-755-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty