Provider Demographics
NPI:1790825297
Name:SPERLING, DEBRA D (DMD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:D
Last Name:SPERLING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 IRMA DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5716
Mailing Address - Country:US
Mailing Address - Phone:718-549-8022
Mailing Address - Fax:718-549-7977
Practice Address - Street 1:100 W MOSHOLU PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1001
Practice Address - Country:US
Practice Address - Phone:718-549-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045368Medicaid