Provider Demographics
NPI:1629114558
Name:GLASGOW, MATTHEW WILLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIS
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 1:222 PROGRESS ST NE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7320
Mailing Address - Country:US
Mailing Address - Phone:540-552-3111
Mailing Address - Fax:540-552-0606
Practice Address - Street 1:222 PROGRESS ST NE
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7320
Practice Address - Country:US
Practice Address - Phone:540-552-3111
Practice Address - Fax:540-552-0606
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice