MEDICARE: GLASSLEY & MARR DENTAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1275603508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLASSLEY & MARR DENTAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	5108 N CLINTON ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5720
Country	:	US
Telephone Number	:	260-482-1551
Fax Number	:

Provider Business Practice Location Address
First Line	:	5108 N CLINTON ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5720
Country	:	US
Telephone Number	:	260-482-1551
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. BRYAN MCGUIGAN THOMPSON
Credential	:	D.D.S
Telephone Number	:	260-482-1551

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	01/14/2021

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