Healthcare Provider Details

I. General information

NPI: 1174661334
Provider Name (Legal Business Name): ALBERN LEE SPOOLSTRA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N BELLFLOWER BLVD SUITE 301
LONG BEACH CA
90815-1129
US

IV. Provider business mailing address

2700 N BELLFLOWER BLVD SUITE 301
LONG BEACH CA
90815-1129
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-8896
  • Fax: 562-429-4776
Mailing address:
  • Phone: 562-421-8896
  • Fax: 562-429-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number21514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: