Healthcare Provider Details

I. General information

NPI: 1588623649
Provider Name (Legal Business Name): ALISON GLASCOE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MITCHELLVILLE RD SUITE 108
BOWIE MD
20716-1389
US

IV. Provider business mailing address

3060 MITCHELLVILLE RD SUITE 108
BOWIE MD
20716-1389
US

V. Phone/Fax

Practice location:
  • Phone: 301-218-8810
  • Fax: 301-218-8421
Mailing address:
  • Phone: 301-218-8810
  • Fax: 301-218-8421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11620
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: