Glen H Petteway, D.D.S., P.C.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

13801 Issued in MO

Legal business name

GLEN H PETTEWAY, D.D.S., P.C.

Practice address

1200 E Woodhurst Dr
BLD T, Suite 300
Springfield, MO 65804-4261

Phone

(417) 887-7114

Fax

(417) 887-2882

NPI assigned

Feb 22, 2016

Last updated

Feb 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Glen H Petteway, D.D.S.NPI 1235322108

Title

Owner

Phone

(417) 887-7114

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glen H Petteway, DDS

  • Prosthodontics
  • Springfield, MO
  • NPI 1235322108
  Authorized official Same address or phone

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456099200000",
    "number": "1356700181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR",
            "address_2": "BLD T, SUITE 300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044261",
            "telephone_number": "417-887-7114",
            "fax_number": "417-887-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR",
            "address_2": "BLD T, SUITE 300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044261",
            "telephone_number": "417-887-7114",
            "fax_number": "417-887-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN H PETTEWAY, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-22",
        "last_updated": "2016-02-22",
        "status": "A",
        "authorized_official_last_name": "PETTEWAY",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-887-7114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MO",
            "license": "13801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Mary Gish, CRNA
• Jay M Givens, D.PH
• Kelsey Brooke Glaser
• Jason R Glass, PSY.D.
• Brooke Glaszczak
• Christopher Lee Glenn, DR
• Jason A. Glenn, P.A.
• Misty D. Glenn, FNP-C
• Shawnee Kay Glenn, CRNA
• Kendall L Glennon, MSW, LCSW

• Prosthodontics in Springfield, MO
• Providers in Springfield, MO by specialty
• Prosthodontics in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.