Provider Demographics
NPI:1821688169
Name:SPATZ, HARRISON ISAAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:ISAAC
Last Name:SPATZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ASH DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2205
Mailing Address - Country:US
Mailing Address - Phone:516-621-9648
Mailing Address - Fax:
Practice Address - Street 1:307 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-5525
Practice Address - Country:US
Practice Address - Phone:215-860-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0617511223P0700X
PADS0438761223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics