Maze, Glenn Ian
Maze, Glenn Ian is an individual health care provider with primary practice located at 1459 Laney Walker Blvd Ad1501, Augusta GA 30912-0002. He recently has only one registered license in Dental Providers / Periodontics, which is considered as his primary health care specialty. Maze, Glenn Ian can be contacted via phone (706) 721-0505.Contact Information
Primary practice address
1459 Laney Walker Blvd Ad1501
Augusta GA 30912-0002
Phone: (706) 721-0505
Fax: (706) 721-6778
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Periodontics | 1223P0300X | DNF000332 | Georgia |
Profile Details
| NPI number | 1740210855 |
|---|---|
| LBN Legal business name | Maze, Glenn Ian |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 4th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740210855 | NPPES |
| South Carolina | MEDICAID | ZG0332 |
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