Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 21824 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 21824 | MA |
NPI | 1275744310 |
---|---|
Provider Name | Dr. Michael Jay Spink |
First Address | Longmeadow, MA 01106-1529 |
Second Address | East Longmeadow, MA 01028-1830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |