Provider Demographics
NPI:1306839717
Name:SPEKHARDT, MICHELE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:E
Last Name:SPEKHARDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4360
Mailing Address - Country:US
Mailing Address - Phone:207-947-7503
Mailing Address - Fax:
Practice Address - Street 1:62 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4360
Practice Address - Country:US
Practice Address - Phone:207-947-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME33561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice