Provider Demographics
NPI:1679756175
Name:SPIELMAN, GREGORY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:SPIELMAN
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 1:2816 NW 58TH STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1902
Mailing Address - Country:US
Mailing Address - Phone:405-848-7780
Mailing Address - Fax:405-949-9762
Practice Address - Street 1:2816 NW 58TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6899
Practice Address - Country:US
Practice Address - Phone:405-848-7780
Practice Address - Fax:405-848-7781
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice