1619075991 NPI number — STEVEN JAMES SPECA DMD

Table of content: STEVEN JAMES SPECA DMD (NPI 1619075991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619075991 NPI number — STEVEN JAMES SPECA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPECA
Provider First Name:
STEVEN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619075991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 FAIRWAY LANDING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANONSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-983-6663
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6660 PEACH ST
Provider Second Line Business Practice Location Address:
SUITE C12 ALLCARE DENTAL & DENTURES PC
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-866-3810
Provider Business Practice Location Address Fax Number:
814-866-7006
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  10625 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DS036064 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10625 . This is a "CO STATE DENTAL LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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