Provider Demographics
NPI:1417038498
Name:GITLIN, GALINA (DMD)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:GITLIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:GALINA
Other - Middle Name:
Other - Last Name:GITLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PC
Mailing Address - Street 1:62 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-863-9826
Mailing Address - Fax:781-863-9829
Practice Address - Street 1:62 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-863-9826
Practice Address - Fax:781-863-9829
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice