Provider Demographics
NPI:1447442637
Name:MATTHEW W GLASGOW DDS PC
Entity type:Organization
Organization Name:MATTHEW W GLASGOW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-552-3111
Mailing Address - Street 1:220 PROGRESS ST NE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7320
Mailing Address - Country:US
Mailing Address - Phone:540-552-3111
Mailing Address - Fax:540-381-9599
Practice Address - Street 1:220 PROGRESS ST NE
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7320
Practice Address - Country:US
Practice Address - Phone:540-552-3111
Practice Address - Fax:540-381-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty