Provider Demographics
NPI:1619218203
Name:STEVEN D. SPITZ, DMD,LLC
Entity Type:Organization
Organization Name:STEVEN D. SPITZ, DMD,LLC
Other - Org Name:SMILEBOSTON PEMBROKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-826-7577
Mailing Address - Street 1:31 SCHOOSETT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1877
Mailing Address - Country:US
Mailing Address - Phone:781-826-7577
Mailing Address - Fax:781-826-8970
Practice Address - Street 1:31 SCHOOSETT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1877
Practice Address - Country:US
Practice Address - Phone:781-826-7577
Practice Address - Fax:781-826-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty