Provider Demographics
NPI:1821274564
Name:GLINKO, TRACEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:S
Last Name:GLINKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WESTERN AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-1382
Mailing Address - Country:US
Mailing Address - Phone:207-238-6235
Mailing Address - Fax:207-238-6236
Practice Address - Street 1:51 WESTERN AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-1382
Practice Address - Country:US
Practice Address - Phone:207-238-6235
Practice Address - Fax:207-238-6236
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist