Provider Demographics
NPI:1437385234
Name:SPECHT, CHARITY JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:JEAN
Last Name:SPECHT
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 1:210 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1130
Mailing Address - Country:US
Mailing Address - Phone:218-885-9921
Mailing Address - Fax:218-885-9921
Practice Address - Street 1:210 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1130
Practice Address - Country:US
Practice Address - Phone:218-885-9921
Practice Address - Fax:218-885-9924
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND126641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice