Provider Demographics
NPI:1366624306
Name:YVETTE GLINA, DDS, LLC
Entity Type:Organization
Organization Name:YVETTE GLINA, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-631-3400
Mailing Address - Street 1:1 SHELDON RD
Mailing Address - Street 2:62 HUMPHREY STREET ENTRANCE
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2024
Mailing Address - Country:US
Mailing Address - Phone:781-631-3400
Mailing Address - Fax:781-631-3464
Practice Address - Street 1:1 SHELDON RD
Practice Address - Street 2:62 HUMPHREY STREET ENTRANCE
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2024
Practice Address - Country:US
Practice Address - Phone:781-631-3400
Practice Address - Fax:781-631-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21031261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12622OtherBLUE CROSS BLUE SHIELD