Provider Demographics
NPI:1073642088
Name:TRINKA, GLEN EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:EDWARD
Last Name:TRINKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19214 BOTHELL WAY NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-6066
Mailing Address - Country:US
Mailing Address - Phone:425-486-2787
Mailing Address - Fax:
Practice Address - Street 1:19214 BOTHELL WAY NE
Practice Address - Street 2:SUITE B
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-6066
Practice Address - Country:US
Practice Address - Phone:425-486-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000061451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice