Organization
FORT WAYNE ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON P GLASSLEY DDS, MSD (PRESIDENT)
(260) 436-5772
Entity
Organization
Contact information
Practice address
9407 ILLINOIS RD, FORT WAYNE, IN 46804
(260) 436-5772
(260) 436-5779
Mailing address
9407 ILLINOIS RD, FORT WAYNE, IN 46804
(260) 436-5772
(260) 436-5779
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
09/26/2019
Last updated
09/26/2019
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