Provider Demographics
NPI:1336361930
Name:LAURA B GLICKSMAN MS DMD PC
Entity Type:Organization
Organization Name:LAURA B GLICKSMAN MS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLICKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS DMD
Authorized Official - Phone:781-449-3560
Mailing Address - Street 1:119 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2515
Mailing Address - Country:US
Mailing Address - Phone:781-449-3560
Mailing Address - Fax:781-449-0116
Practice Address - Street 1:119 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2515
Practice Address - Country:US
Practice Address - Phone:781-449-3560
Practice Address - Fax:781-449-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty