Provider Demographics
NPI:1821018243
Name:SPIEKER DENTAL, INC
Entity Type:Organization
Organization Name:SPIEKER DENTAL, INC
Other - Org Name:CLARK FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, SPIEKER DENTAL, INC
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SPIEKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-532-3636
Mailing Address - Street 1:415 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225-1320
Mailing Address - Country:US
Mailing Address - Phone:605-532-3636
Mailing Address - Fax:605-532-3934
Practice Address - Street 1:415 1ST AVE W
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:SD
Practice Address - Zip Code:57225-1320
Practice Address - Country:US
Practice Address - Phone:605-532-3636
Practice Address - Fax:605-532-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4351223G0001X
SDD04031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD=========Medicare UPIN