Provider Demographics
NPI:1457448482
Name:WINDMILLER, GLORY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLORY
Middle Name:LYNN
Last Name:WINDMILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GLORY
Other - Middle Name:L
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 CRAFTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4815
Mailing Address - Country:US
Mailing Address - Phone:214-425-0649
Mailing Address - Fax:
Practice Address - Street 1:3503 W BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2124
Practice Address - Country:US
Practice Address - Phone:660-460-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208631223G0001X
MO20170282361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151048910Medicaid