Individual
DR. MICHAEL ROBERT GLASSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1612 SPRING ST, FORT WAYNE, IN 46808-3097
(260) 426-3068
Mailing address
1612 SPRING ST, FORT WAYNE, IN 46808-3097
(260) 426-3068
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12006497
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084319
ANTHEMBCBS
IN
01
—
4729
PHP
IN
Enumeration date
08/19/2006
Last updated
07/08/2007
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