Provider Demographics
NPI:1083274021
Name:SPEVAK, ALEKSANDR (DDS)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:SPEVAK
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 1:605 CANE MILL CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6297
Mailing Address - Country:US
Mailing Address - Phone:518-281-9330
Mailing Address - Fax:
Practice Address - Street 1:1971 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7890
Practice Address - Country:US
Practice Address - Phone:843-871-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583271223G0001X
SCDGD98731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice