Provider Demographics
NPI:1265629778
Name:SPECTOR, DANIELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VANDERVENTER AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3737
Mailing Address - Country:US
Mailing Address - Phone:516-883-0584
Mailing Address - Fax:
Practice Address - Street 1:14 VANDERVENTER AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3737
Practice Address - Country:US
Practice Address - Phone:516-883-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist