Provider Demographics
NPI:1356554174
Name:LOUIS V. SPICCIATI DDS PC
Entity type:Organization
Organization Name:LOUIS V. SPICCIATI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SPICCIATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-597-2400
Mailing Address - Street 1:3233 W CAREFREE CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3004
Mailing Address - Country:US
Mailing Address - Phone:719-597-2400
Mailing Address - Fax:719-573-5633
Practice Address - Street 1:3233 W CAREFREE CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3004
Practice Address - Country:US
Practice Address - Phone:719-597-2400
Practice Address - Fax:719-573-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty