Healthcare Provider Details

I. General information

NPI: 1043204027
Provider Name (Legal Business Name): JOSEPH F SPERA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FOULK RD
WILMINGTON DE
19810-4710
US

IV. Provider business mailing address

2101 FOULK RD
WILMINGTON DE
19810-4710
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-1122
  • Fax: 302-475-1151
Mailing address:
  • Phone: 302-475-1122
  • Fax: 302-475-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1158
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: