Individual
DR. GLENN TAYLOR MATTLAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4415 66TH ST, SUITE 112, LUBBOCK, TX 79414-4809
(806) 797-1275
Mailing address
4415 66TH ST, SUITE 112, LUBBOCK, TX 79414-4809
(806) 797-1275
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
12592
TX
1223P0300X
Periodontics
Primary
DD1382
NM
Other
Enumeration date
01/17/2006
Last updated
08/26/2014
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