Provider Demographics
NPI:1730333949
Name:SPECTOR, SARA WOLFE (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:WOLFE
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 N TALL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5065
Mailing Address - Country:US
Mailing Address - Phone:614-353-4894
Mailing Address - Fax:
Practice Address - Street 1:5454 N TALL OAKS DR
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5065
Practice Address - Country:US
Practice Address - Phone:614-353-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0326741223X0400X
IL0190326741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics