Organization
GLEN H PETTEWAY, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN H PETTEWAY D.D.S. (OWNER)
(417) 887-7114
Entity
Organization
Contact information
Practice address
1200 E WOODHURST DR, BLD T, SUITE 300, SPRINGFIELD, MO 65804-4261
(417) 887-7114
(417) 887-2882
Mailing address
1200 E WOODHURST DR, BLD T, SUITE 300, SPRINGFIELD, MO 65804-4261
(417) 887-7114
(417) 887-2882
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
13801
MO
Other
Enumeration date
02/22/2016
Last updated
02/22/2016
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