Provider Demographics
NPI:1861526378
Name:SPERBECK, GLENN LUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:LUIS
Last Name:SPERBECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3902
Mailing Address - Country:US
Mailing Address - Phone:310-670-6944
Mailing Address - Fax:310-641-2785
Practice Address - Street 1:6206 W 87TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3902
Practice Address - Country:US
Practice Address - Phone:310-670-6944
Practice Address - Fax:310-641-2785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice