Organization
KIDS DENTAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M GLASS DDS (OWNER/DENTIST)
(903) 831-1000
Entity
Organization
Contact information
Practice address
908 W MAIN ST, ATLANTA, TX 75551-3430
(903) 831-1000
Mailing address
908 W MAIN ST, ATLANTA, TX 75551-3430
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
26442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282579601
—
TX
Enumeration date
08/31/2015
Last updated
08/31/2015
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