Provider Demographics
NPI:1669494704
Name:SPECHLER, JEROME W (DDS)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:W
Last Name:SPECHLER
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 1:3610 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1042
Mailing Address - Country:US
Mailing Address - Phone:703-578-4221
Mailing Address - Fax:703-578-1228
Practice Address - Street 1:3610 FOREST DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1042
Practice Address - Country:US
Practice Address - Phone:703-578-4221
Practice Address - Fax:703-578-1228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice