Individual
JASON PATRICK GLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
357 E 4TH ST, WAHOO, NE 68066-1920
(402) 443-5959
Mailing address
357 E 4TH ST, WAHOO, NE 68066-1920
(402) 443-5959
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6253
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04786
BLUE CROSS AND BLUE SHIEL
—
05
—
10025583000
—
NE
Enumeration date
01/02/2008
Last updated
01/02/2008
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