Provider Demographics
NPI:1710114822
Name:SPEKTOR, MARINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SPEKTOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 STUART AVE
Mailing Address - Street 2:APT.#3
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3521
Mailing Address - Country:US
Mailing Address - Phone:804-218-6364
Mailing Address - Fax:
Practice Address - Street 1:1903 STUART AVE
Practice Address - Street 2:APT.#3
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3521
Practice Address - Country:US
Practice Address - Phone:804-218-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124531223D0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223P0221XDental ProvidersDentistPediatric Dentistry