Provider Demographics
NPI:1710196225
Name:SPIELVOGEL, BRETT (DDS)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:SPIELVOGEL
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 1:430 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2805
Mailing Address - Country:US
Mailing Address - Phone:914-939-1185
Mailing Address - Fax:914-939-5788
Practice Address - Street 1:430 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-2805
Practice Address - Country:US
Practice Address - Phone:914-939-1185
Practice Address - Fax:914-939-5788
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038976-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice