MEDICARE: DR. STEVEN ROBERT SPIVAK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	62528	CA

General Provider Information

NPI Number	:	1861825895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ROBERT SPIVAK D.M.D.

Provider Business Mailing Address
First Line	:	5410 RHODES AVENUE
Second Line	:	#102
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2079
Country	:	US
Telephone Number	:	818-687-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	13114 SHERMAN WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4645
Country	:	US
Telephone Number	:	818-982-6162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	10/12/2015

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