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General NPI Number Information
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NPI Number | 1467760850
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Entity Type | Individual
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Provider Name | GLENN THOMAS ASHWORTH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 3820 PACIFIC AVE SUITE 101
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City | TACOMA
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State | WA
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Zip | 98418-7825
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Country | US
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Telephone | 716-425-6295
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 PACIFIC AVE SUITE 101
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City | TACOMA
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State | WA
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Zip | 98418-7825
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Country | US
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Telephone | 716-425-6295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14600
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60462145
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License Number State | WA
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