MEDICARE: DR. GREGORY S GLASSLEY DDS

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	7471	IN

General Provider Information

NPI Number	:	1306051354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY S GLASSLEY DDS

Provider Business Mailing Address
First Line	:	5108 N. CLINTON STREET
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	07/08/2007

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