Glenn Taylor Mattlage, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DD1382 Issued in NM

Practice address

4415 66TH St
Suite 112
Lubbock, TX 79414-4809

Phone

(806) 797-1275

NPI assigned

Jan 17, 2006

Last updated

Aug 26, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lubbock Dental Implant Center PLLC

  dba Lubbock Perio & Implant Center

  • Periodontics
  • Lubbock, TX
  • NPI 1558743872
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409011200000",
    "number": "1184603243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4415 66TH ST",
            "address_2": "SUITE 112",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794144809",
            "telephone_number": "806-797-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 66TH ST",
            "address_2": "SUITE 112",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794144809",
            "telephone_number": "806-797-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTLAGE",
        "first_name": "GLENN",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2014-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NM",
            "license": "DD1382",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "12592",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mayme Alicia Matthews
• Timothy Scott Matthews, ATC, OTC
• Holly Mattia
• Mattison Pathology, L.L.P. (Avero Diagnostics)
• Michael Trae Mattison, M.D.
• Maupin Endodontics & Microsurgery PLLC (Maupin Endodontics)
• Charles Thomas Maupin, D.D.S.
• Maxim Healthcare Services, Inc.
• Maxor National Pharmacy Services LLC (Maxor Specialty Pharmacy)
• Maxor National Pharmacy Services LLC (Maxor Specialty Pharmacy)

• Periodontics in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.