Provider Demographics
NPI:1013054279
Name:GLAVIN, JEFFREY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:GLAVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 TECHNOLOGY PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-8336
Mailing Address - Country:US
Mailing Address - Phone:508-759-2724
Mailing Address - Fax:508-759-1402
Practice Address - Street 1:1 TECHNOLOGY PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-8336
Practice Address - Country:US
Practice Address - Phone:508-759-2724
Practice Address - Fax:508-759-1402
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice