MEDICARE: DR. CLINTON E SPICER DDS

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	1223G0001X	General Practice Dentistry	0440281	NY

General Provider Information

NPI Number	:	1609914548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINTON E SPICER DDS

Provider Business Mailing Address
First Line	:	315 HAWTHORNE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5909
Country	:	US
Telephone Number	:	347-200-9659
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W 132ND ST
Second Line	:	SUITE 1N
City	:	NEW YORK
State	:	NY
Zip	:	10037-3101
Country	:	US
Telephone Number	:	212-862-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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