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General NPI Number Information
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NPI Number | 1811449291
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Entity Type | Organization
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Legal Business Name | BRIAN D SPERBER DDS LLC
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 1112 LINCOLN ST
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City | KEWAUNEE
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State | WI
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Zip | 54216-1602
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Country | US
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Telephone | 920-388-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 LINCOLN ST
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City | KEWAUNEE
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State | WI
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Zip | 54216-1602
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Country | US
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Telephone | 920-388-5200
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. BRIAN DANIEL SPERBER
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Credential | D.D.S.
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Telephone | 920-388-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7073
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License Number State | WI
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