Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 ERMA RD STE 110
SAN DIEGO CA
92131-3001
US

IV. Provider business mailing address

9855 ERMA RD STE 110
SAN DIEGO CA
92131-3001
US

V. Phone/Fax

Practice location:
  • Phone: 858-578-2205
  • Fax: 858-578-1753
Mailing address:
  • Phone: 858-578-2205
  • Fax: 858-578-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6252
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number20492
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number27073
License Number StateCA

VIII. Authorized Official

Name: DR. SIDNEY LLOYD SPECTOR
Title or Position: OWNER
Credential: DDS
Phone: 858-578-2205