Provider Demographics
NPI:1891720959
Name:SPIEGEL, MICHAEL S (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SPIEGEL
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 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2820
Mailing Address - Country:US
Mailing Address - Phone:732-634-0062
Mailing Address - Fax:732-634-7602
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2820
Practice Address - Country:US
Practice Address - Phone:732-634-0062
Practice Address - Fax:732-634-7602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 009973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist