Healthcare Provider Details

I. General information

NPI: 1275744310
Provider Name (Legal Business Name): MICHAEL JAY SPINK DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 HIGH ST
GREENFIELD MA
01301-2608
US

IV. Provider business mailing address

33 OXFORD RD
LONGMEADOW MA
01106-1529
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-3709
  • Fax:
Mailing address:
  • Phone: 646-522-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21824
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number21824
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: