| Glen H Petteway, D.d.s., P.c. | |
|
1200 E Woodhurst Dr Bld T, Suite 300 Springfield MO 65804-4261 | |
| (417) 887-7114 | |
| (417) 887-2882 |
| Full Name | Glen H Petteway, D.d.s., P.c. |
|---|---|
| Speciality | Dentist - Prosthodontics |
| Location | 1200 E Woodhurst Dr, Springfield, Missouri |
| Authorized Official Name and Position | Glen H Petteway (OWNER) |
| Authorized Official Contact | 4178877114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen H Petteway, D.d.s., P.c. 1200 E Woodhurst Dr Bld T, Suite 300 Springfield MO 65804-4261 Ph: (417) 887-7114 | Glen H Petteway, D.d.s., P.c. 1200 E Woodhurst Dr Bld T, Suite 300 Springfield MO 65804-4261 Ph: (417) 887-7114 |
| NPI Number | 1356700181 |
|---|---|
| Provider Enumeration Date | 02/22/2016 |
| Last Update Date | 02/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356700181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 13801 (Missouri) | Primary |
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