Provider Demographics
NPI:1891884490
Name:SPINELLI, GLEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:M
Last Name:SPINELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MAHOGANY RUN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-9424
Mailing Address - Country:US
Mailing Address - Phone:585-249-0414
Mailing Address - Fax:
Practice Address - Street 1:2070 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5715
Practice Address - Country:US
Practice Address - Phone:585-458-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist