Provider Demographics
NPI:1053575068
Name:GLICKSMAN, LAURA B (MS DMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:GLICKSMAN
Suffix:
Gender:F
Credentials:MS DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHESTNUT ST
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 ST
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics