Basic Information
| Provider Information | |||||||||
| NPI: | 1730179326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLAZE | ||||||||
| FirstName: | SHARIAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5018 E CAPITOL ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200195326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023887735 | ||||||||
| FaxNumber: | 2023885202 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 45TH ST NE | ||||||||
| Address2: | DENTAL DEPT. | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200194632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023887735 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DEN1000568 | DC | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 12728 | MD | N | Dental Providers | Dentist | General Practice |
No ID Information.