GLEN H PETTEWAY, D.D.S., P.C. (NPI# 1356700181) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1356700181 |
Entity Type | Organization |
Organization Name | GLEN H PETTEWAY, D.D.S., P.C. |
Practice Address |
1200 E Woodhurst Dr Bld T, Suite 300 Springfield MO 65804-4261 |
Practice Telephone | 4178877114 |
Practice Fax Number | 4178872882 |
Mailing Telephone | 4178877114 |
Mailing Fax Number | 4178872882 |
Enumeration Date | 2016-02-22 |
Last Update Date | 2016-02-22 |
Authorized Official Name | DR. GLEN H PETTEWAY (OWNER) |
Authorized Official Telephone | 4178877114 |
Authorized Official Credential | D.D.S. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
13801 | MO | Dental Providers |
Street Address |
1200 E WOODHURST DR BLD T, SUITE 300 |
City | SPRINGFIELD |
State | MO |
Zip Code | 65804-4261 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366444663 | Thomas Joseph Meyer | Dentist | 1200 E Woodhurst Dr, Ste H200, Springfield, MO 65804-3776 | 2005-06-01 |
1770031759 | Patricia Wagner | Nurse Practitioner | 1200 E Woodhurst Dr, Q200, Springfield, MO 65804-4261 | 2016-09-19 |
1043691462 | Ascend Dental Design, LLC | Clinic/Center | 1200 E Woodhurst Dr, Building U, Springfield, MO 65804-4240 | 2015-06-11 |
1699170159 | Geosling Chiropractic Clinic, Inc | Clinic/Center | 1200 E Woodhurst Dr, Suite L200, Springfield, MO 65804-4261 | 2014-10-27 |
1336560010 | Thomas F, Hoff, Dds, LLC | Dentist | 1200 E Woodhurst Dr, Building F Suite 100, Springfield, MO 65807-4261 | 2013-12-23 |
1801234828 | Derek J Magers | Dentist | 1200 E Woodhurst Dr, Building U, Springfield, MO 65804-4261 | 2013-06-12 |
1073805776 | Wellness Concepts Clinic | Chiropractor | 1200 E Woodhurst Dr, Suite R300, Springfield, MO 65804-4261 | 2011-05-12 |
1124310107 | Candace Wawra | Hearing Instrument Specialist | 1200 E Woodhurst Dr, Suite Q Building 100, Springfield, MO 65804-4261 | 2011-05-09 |
1437450970 | Springfield Hearing Center | Hearing Instrument Specialist | 1200 E Woodhurst Dr, Suite Q-100, Springfield, MO 65804-4261 | 2010-11-16 |
1699007286 | Wayne B Miles Md PC | Internal Medicine | 1200 E Woodhurst Dr, Bldg K Suite 300, Springfield, MO 65804-4261 | 2010-02-05 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
Find all providers in zip 65804 |
Taxonomy Code | 1223P0700X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Prosthodontics |
That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
Notes: Source: Council on Dental Education and Licensure, American Dental Association |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487958112 | Carol Kim | Dentist | 3842 S Glenstone Ave, Springfield, MO 65804-4418 | 2011-01-11 |
1972750909 | Kevin D Wallace | Dentist | 1200 E Woodhurst Dr Ste A200, Springfield, MO 65804-3745 | 2008-08-21 |
1235322108 | Glen H Petteway | Dentist | 1200 E Woodhurst, Ste T300, Springfield, MO 65804-3784 | 2007-08-23 |
1841404019 | Kevin D Wallace Dmd, PC | Dentist | 1200 E Woodhurst Dr, Suite 200-a, Springfield, MO 65804-4257 | 2007-05-09 |
1205944105 | Robert Lee Swords | Dentist | 618 N Benton Ave, Springfield, MO 65806-1102 | 2006-08-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629605019 | Bhavika V Thakkar | Dentist | 650 E 25th St Rm 277, Kansas City, MO 64108-2716 | 2020-03-25 |
1285159004 | C. Alan Mcquigg Dds Ms PC | Dentist | 620 W 32nd St Ste C, Joplin, MO 64804-2528 | 2017-08-14 |
1770011926 | Azadeh Afshari, Dds LLC | Dentist | 517 S Euclid Ave Bldg Ste 819, Saint Louis, MO 63110-1007 | 2017-06-01 |
1881899466 | Warren Henry Speiser | Dentist | 885 St Francois Street, Florissant, MO 63031-4923 | 2007-06-15 |
1134282023 | Kristine Kae Schrock | Dentist | 3906 Sherman Ave, Saint Joseph, MO 64506-3648 | 2006-12-19 |
1487740189 | Kyle Donahue | Dentist | 2020 Bluestone Dr, Saint Charles, MO 63303-5974 | 2006-10-04 |
1093738858 | Richard Blustein | Dentist | 711 N New Ballas Rd, Saint Louis, MO 63141-6715 | 2006-07-25 |
1265479885 | Donna N Deines | Dentist | 203 E 63rd St, Kansas City, MO 64113-2224 | 2006-06-01 |
1669443990 | Timothy Scott Bartlett | Dentist | 1497 N Business Route 5, Camdenton, MO 65020-2636 | 2006-01-26 |
1841629557 | Clarence Elrod | Dentist | 650 E 25th St, School of Dentistry, Kansas City, MO 64108-2716 | 2013-11-03 |
Find all providers with the same taxonomy |
City | SPRINGFIELD |
Zip Code | 65804 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.