Individual
DR. MAGDALENA GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
3050 FIVE FORKS TRICKUM RD SW STE H, LILBURN, GA 30047-1877
(770) 982-7533
Mailing address
3050 FIVE FORKS TRICKUM RD SW STE H, LILBURN, GA 30047-1877
(770) 982-7533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122208
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN122208
GEORGIA DENTAL LICENSE
GA
Enumeration date
01/05/2021
Last updated
03/07/2023
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