Provider Demographics
NPI:1417315953
Name:SVETCOV, SPENCER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:SVETCOV
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 1:41 WYNDHAM CLOSE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2100
Mailing Address - Country:US
Mailing Address - Phone:914-437-7013
Mailing Address - Fax:
Practice Address - Street 1:20906 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11364-3238
Practice Address - Country:US
Practice Address - Phone:718-479-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY50 058680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program