Provider Demographics
NPI:1659537637
Name:SPEARS, MICHAEL HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HAROLD
Last Name:SPEARS
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 1:232 W FRANKLIN AVE
Mailing Address - Street 2:#108
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2300
Mailing Address - Country:US
Mailing Address - Phone:612-870-8689
Mailing Address - Fax:612-749-7805
Practice Address - Street 1:232 W FRANKLIN AVE
Practice Address - Street 2:#108
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2300
Practice Address - Country:US
Practice Address - Phone:612-870-8689
Practice Address - Fax:612-749-7805
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7476Medicare PIN