Provider Demographics
NPI:1609034156
Name:GLASGOW, MARK JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:GLASGOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 6TH AVE
Mailing Address - Street 2:WELLINGTON-WEBB BLDG 3RD FLOOR
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-5182
Mailing Address - Country:US
Mailing Address - Phone:303-602-8212
Mailing Address - Fax:
Practice Address - Street 1:301 W 6TH AVE
Practice Address - Street 2:WELLINGTON-WEBB BLDG 3RD FLOOR
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5182
Practice Address - Country:US
Practice Address - Phone:303-602-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-85051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery