Provider Demographics
NPI:1902919269
Name:SIDNEY L. SPECTOR, DDS, PROF. CORP,
Entity Type:Organization
Organization Name:SIDNEY L. SPECTOR, DDS, PROF. CORP,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-578-2205
Mailing Address - Street 1:9855 ERMA RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3001
Mailing Address - Country:US
Mailing Address - Phone:858-578-2205
Mailing Address - Fax:858-578-1753
Practice Address - Street 1:9855 ERMA RD
Practice Address - Street 2:STE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3001
Practice Address - Country:US
Practice Address - Phone:858-578-2205
Practice Address - Fax:858-578-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270731223P0300X
CA6252124Q00000X
CA20492124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty