Provider Demographics
NPI:1083738264
Name:SPECTOR, COLEMAN JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:JAY
Last Name:SPECTOR
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 1:1014 W. BELMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-472-5235
Mailing Address - Fax:773-472-6321
Practice Address - Street 1:1014 W. BELMONT AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-472-5235
Practice Address - Fax:773-472-6321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.001732019.0239161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery