1043204027 NPI number — DR. JOSEPH F SPERA DMD

Table of content: DR. JOSEPH F SPERA DMD (NPI 1043204027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043204027 NPI number — DR. JOSEPH F SPERA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPERA
Provider First Name:
JOSEPH
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
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:
1043204027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 FOULK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-4710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-475-1122
Provider Business Mailing Address Fax Number:
302-475-1151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 FOULK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-475-1122
Provider Business Practice Location Address Fax Number:
302-475-1151
Provider Enumeration Date:
09/07/2005

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: 1223S0112X , with the licence number:  1158 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000032546 . This is a "DELAWARE PHYS CARE INC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0001189701 . This is a "DIAMOND STATE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2843429 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 177496 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0001189701 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731651766 . This is a "BCBS OF DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 731651766 . This is a "DELTA DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 731651766 . This is a "GUARDIAN DENTAL" identifier . This identifiers is of the category "OTHER".




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