Provider Demographics
NPI:1326060476
Name:SPIVAK, BRUCE HOWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HOWARD
Last Name:SPIVAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 WALNUT BOTTOM RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3632
Mailing Address - Country:US
Mailing Address - Phone:717-243-5434
Mailing Address - Fax:717-245-2384
Practice Address - Street 1:850 WALNUT BOTTOM RD
Practice Address - Street 2:SUITE 303
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3632
Practice Address - Country:US
Practice Address - Phone:717-243-5434
Practice Address - Fax:717-245-2384
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025686L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice