Provider Demographics
NPI:1609914548
Name:SPICER, CLINTON E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:E
Last Name:SPICER
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 1:315 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5909
Mailing Address - Country:US
Mailing Address - Phone:347-200-9659
Mailing Address - Fax:
Practice Address - Street 1:45 W 132ND ST
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3101
Practice Address - Country:US
Practice Address - Phone:212-862-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04402811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice