Provider Demographics
NPI:1053448928
Name:SPEISER, ABRAHAM M (DDS)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:M
Last Name:SPEISER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PARK PL
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-5511
Mailing Address - Country:US
Mailing Address - Phone:973-732-3208
Mailing Address - Fax:973-732-3207
Practice Address - Street 1:60 PARK PL
Practice Address - Street 2:SUITE 1107
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-5511
Practice Address - Country:US
Practice Address - Phone:973-732-3208
Practice Address - Fax:973-732-3207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D100918700122300000X
NY029107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0700100Medicaid
NJ000310002Medicaid
NY29107OtherDENTAL LICENSE
NJ22D100918700OtherDENTAL LICENSE
T77631Medicare UPIN
NJ000310002Medicaid