Provider Demographics
NPI:1124192471
Name:SPERO, ROBERT L (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:SPERO
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9410
Mailing Address - Country:US
Mailing Address - Phone:740-593-3794
Mailing Address - Fax:740-593-6214
Practice Address - Street 1:715 W UNION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9410
Practice Address - Country:US
Practice Address - Phone:740-593-3794
Practice Address - Fax:740-593-6214
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0524301Medicaid