Provider Demographics
NPI:1497973846
Name:SPRECHMAN, KENNETH C (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:SPRECHMAN
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 1:1100 SW SAINT LUCIE WEST BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1779
Mailing Address - Country:US
Mailing Address - Phone:772-878-1900
Mailing Address - Fax:772-878-1924
Practice Address - Street 1:1100 SW SAINT LUCIE WEST BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1779
Practice Address - Country:US
Practice Address - Phone:772-878-1900
Practice Address - Fax:772-878-1924
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics