Provider Demographics
NPI:1033699236
Name:KOUTCHEKPOUR & SPERO, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KOUTCHEKPOUR & SPERO, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-725-6700
Mailing Address - Street 1:100 CITADEL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1579
Mailing Address - Country:US
Mailing Address - Phone:323-725-6700
Mailing Address - Fax:323-725-0756
Practice Address - Street 1:100 CITADEL DR STE 101
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1579
Practice Address - Country:US
Practice Address - Phone:323-725-6700
Practice Address - Fax:323-725-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty