DR. GLENN TAYLOR MATTLAGE DDS NPI 1184603243

NPI Information

  • NPI: 1184603243
  • Provider Name: DR. GLENN TAYLOR MATTLAGE, DDS
  • Classification: Dentist - 1223P0300X
  • Specialization: Periodontics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4415 66TH ST
    SUITE 112
    LUBBOCK, TX
    ZIP 79414
  • Phone: (806) 797-1275

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NPI Details

DR. Glenn Taylor Mattlage, DDS is a periodontics dentist in Lubbock, TX. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. DR. Glenn Taylor Mattlage, DDS NPI is 1184603243. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4415 66TH ST
SUITE 112
LUBBOCK, TX
ZIP 79414-809
Phone: (806) 797-1275

The NPI 1184603243 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 1/17/2006 and was last updated on 8/26/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodonticsDD1382NEW MEXICOYes
21223P0300XDentistPeriodontics12592TEXASNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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