MEDICARE: SIDNEY L. SPECTOR, DDS, PROF. CORP,

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	124Q00000X	Dental Hygienist	6252	CA
2	124Q00000X	Dental Hygienist	20492	CA
3	1223P0300X	Periodontics	27073	CA

General Provider Information

NPI Number	:	1902919269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIDNEY L. SPECTOR, DDS, PROF. CORP,

Provider Business Mailing Address
First Line	:	9855 ERMA RD
Second Line	:	STE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3001
Country	:	US
Telephone Number	:	858-578-2205
Fax Number	:	858-578-1753

Provider Business Practice Location Address
First Line	:	9855 ERMA RD
Second Line	:	STE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3001
Country	:	US
Telephone Number	:	858-578-2205
Fax Number	:	858-578-1753

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SIDNEY LLOYD SPECTOR
Credential	:	DDS
Telephone Number	:	858-578-2205

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	05/01/2009

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