DR. GLENN IAN MAZE (NPI# 1740210855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740210855 |
| Entity Type | Individual |
| Full Name | DR. GLENN IAN MAZE |
| Credential | DDS |
| Practice Address |
1459 Laney Walker Blvd Ad1501 Augusta GA 30912-0002 |
| Practice Telephone | 7067210505 |
| Practice Fax Number | 7067216778 |
| Mailing Telephone | 7067210505 |
| Mailing Fax Number | 7067216778 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
DNF000332 | GA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | ZG0332 | 05 |
| Street Address |
1459 LANEY WALKER BLVD AD1501 |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912-0002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639158900 | Walter Jack Morris | Dentist | 1459 Laney Walker Blvd, Ad1501, Augusta, GA 30912-0002 | 2006-01-13 |
| 1932725694 | Liniya Tauhidul | Family Medicine | 1459 Laney Walker Blvd, Augusta, GA 30912-0002 | 2020-06-18 |
| 1740805852 | Nafiz Kalam Sheikh | Psychiatry & Neurology | 1459 Laney Walker Blvd, Augusta, GA 30912-0001 | 2020-06-15 |
| 1265057426 | Mallika Patel | Internal Medicine | 1459 Laney Walker Blvd, Augusta, GA 30912-0002 | 2020-06-13 |
| 1578188728 | Dhruti Prashant Diwan | Anesthesiology | 1459 Laney Walker Blvd, Augusta, GA 30912-3529 | 2020-06-13 |
| 1043835317 | Jesse William Wayson | Obstetrics & Gynecology | 1459 Laney Walker Blvd, Augusta, GA 30912-0002 | 2020-06-12 |
| 1861017139 | Mac Bohanan | Psychiatry & Neurology | 1459 Laney Walker Blvd, Augusta, GA 30912-0002 | 2020-06-12 |
| 1609491950 | Taylor Payne | Internal Medicine | 1459 Laney Walker Blvd, Augusta, GA 30912-0002 | 2020-06-12 |
| 1184249443 | Yasasvi Tadavarthi | Internal Medicine | 1459 Laney Walker Blvd, Ae 3042, Augusta, GA 30912-0004 | 2020-06-12 |
| 1376168807 | Erica Demaagd | Pediatrics | 1459 Laney Walker Blvd, Ae 3042, Augusta, GA 30912 | 2020-06-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801420146 | Scott Hansen Lowry | Dentist | 1430 John Wesley Drive, Augusta, GA 30912-0001 | 2020-02-25 |
| 1871948695 | Kyle Garrett | Dentist | 2704 W Terrace Dr, Augusta, GA 30909-3622 | 2016-04-29 |
| 1841507928 | Cristiano Susin | Dentist | 1120 15th St # Ad1430, Mcg School of Dentistry Dept Periodontics, Augusta, GA 30912-0004 | 2010-09-09 |
| 1699810366 | Christopher William Cutler | Dentist | 1120 15th St # Gc-1335, Ghsu-college of Dental Medicine, Augusta, GA 30912-0004 | 2007-02-21 |
| 1891846754 | David W. Perrry | Dentist | 231 Davis Rd, Augusta, GA 30907-2407 | 2007-01-16 |
| 1952465742 | Jeffrey Jerome Dent | Dentist | 1238 Augusta West Pkwy, Augusta, GA 30909-1854 | 2006-12-19 |
| 1891714135 | Mark A Brunner | Dentist | 1430 John Wesley Gilbert Dr., Gc-1333, Augusta, GA 30327-3007 | 2006-07-18 |
| 1417900929 | Philip J Hanes | Dentist | 1430 John Wesley Gilbert, Gc-1024, Augusta, GA 30912-1001 | 2006-05-18 |
| 1073112512 | Celine Joyce Cornelius Timothius | Dentist | 1430 John Wesley Gilbert Dr, Augusta, GA 30912-0001 | 2020-10-24 |
| 1144671397 | Mira Ghaly | Dentist | 1430 John Wesley Gilbert Dr, Augusta, GA 30912-0001 | 2016-06-29 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.