Provider Demographics
NPI:1275603508
Name:GLASSLEY & MARR DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:GLASSLEY & MARR DENTAL GROUP, P.C.
Other - Org Name:MARR & THOMPSON DENTAL GROUP, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MCGUIGAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-482-1551
Mailing Address - Street 1:5108 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5720
Mailing Address - Country:US
Mailing Address - Phone:260-482-1551
Mailing Address - Fax:
Practice Address - Street 1:5108 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5720
Practice Address - Country:US
Practice Address - Phone:260-482-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty