Magdalena Glass, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN122208 Issued in GA

Practice address

3050 Five Forks Trickum Rd SW Ste H
Lilburn, GA 30047-1877

Phone

(770) 982-7533

NPI assigned

Jan 5, 2021

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1669060687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 FIVE FORKS TRICKUM RD SW STE H",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471877",
            "telephone_number": "770-982-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 FIVE FORKS TRICKUM RD SW STE H",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471877",
            "telephone_number": "770-982-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASS",
        "first_name": "MAGDALENA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2023-03-07",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA DENTAL LICENSE",
            "identifier": "DN122208",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgia Prenatal LLC
• Georgia Regional Behavioral Services
• Elizabeth Gerber
• Janet Faye Gibbs, LCSW
• John Ryan Gilleland, D.M.D.
• Glenn R. Parris, MD PC
• Goat & Snowflake, LLC
• Golden Strides Behavioral Health, LLC
• Elian Gomez Azcarate Renero, COMMUNITY SUPPORT IN
• Kristen Gonzales, PHARMD.

• Dentist in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.