Provider Demographics
NPI:1497283394
Name:SPERA, MARCUS HERMAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:HERMAN
Last Name:SPERA
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 1:565 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1953
Mailing Address - Country:US
Mailing Address - Phone:607-754-2273
Mailing Address - Fax:
Practice Address - Street 1:565 HOOPER RD
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-1953
Practice Address - Country:US
Practice Address - Phone:315-464-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY59836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty