Provider Demographics
NPI:1760582274
Name:EDWARD SPYRKA DDS P.C.
Entity Type:Organization
Organization Name:EDWARD SPYRKA DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPYRKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-565-0373
Mailing Address - Street 1:24326 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2234
Mailing Address - Country:US
Mailing Address - Phone:313-565-0373
Mailing Address - Fax:
Practice Address - Street 1:24326 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2234
Practice Address - Country:US
Practice Address - Phone:313-565-0373
Practice Address - Fax:313-565-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI158531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty