Provider Demographics
NPI:1265507347
Name:JEFFREY J GLAVIN DDS INC
Entity Type:Organization
Organization Name:JEFFREY J GLAVIN DDS INC
Other - Org Name:BOURNE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-759-2724
Mailing Address - Street 1:1 TECHNOLOGY PARK DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-8336
Mailing Address - Country:US
Mailing Address - Phone:508-759-2724
Mailing Address - Fax:508-759-1402
Practice Address - Street 1:1 TECHNOLOGY PARK DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-8336
Practice Address - Country:US
Practice Address - Phone:508-759-2724
Practice Address - Fax:508-759-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163031223G0001X
MA710631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty