Ethan Christopher Glock

NPI #1962086827 in Fort Carson, Colorado

Provider Information

NPI Number: 1962086827
Entity Type: Individual
Name: Ethan Christopher Glock
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Enumeration Date: May 7, 2021
Last Updated: May 7, 2021

Practice Location

Address: 1667 COCHRANE CIR BLDG 7495
City: Fort Carson
State: Colorado
ZIP Code: 80913-4603
Phone: (719) 526-5537

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Assistant	126800000X	Primary

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