Provider Demographics
NPI:1376756569
Name:GLEN COVE DENTAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:GLEN COVE DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-754-5444
Mailing Address - Street 1:1060 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-3801
Mailing Address - Country:US
Mailing Address - Phone:207-596-6349
Mailing Address - Fax:
Practice Address - Street 1:1060 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3801
Practice Address - Country:US
Practice Address - Phone:207-596-6349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty