Provider Demographics
NPI:1073376331
Name:GLASGOW FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:GLASGOW FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-994-8822
Mailing Address - Street 1:3440 FEDERAL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3523
Mailing Address - Country:US
Mailing Address - Phone:651-994-8822
Mailing Address - Fax:
Practice Address - Street 1:3440 FEDERAL DR STE 240
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3523
Practice Address - Country:US
Practice Address - Phone:651-994-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty