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Individual

DR. GLENN IAN MAZE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1459 LANEY WALKER BLVD, AD1501, AUGUSTA, GA 30912-0002
(706) 721-0505
(706) 721-6778
Mailing address
1459 LANEY WALKER BLVD, AD1501, AUGUSTA, GA 30912-0002
(706) 721-0505
(706) 721-6778

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DNF000332
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
ZG0332
SC
Enumeration date
07/04/2006
Last updated
04/19/2026
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