Provider Demographics
NPI:1811449291
Name:BRIAN D SPERBER DDS LLC
Entity type:Organization
Organization Name:BRIAN D SPERBER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SPERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-388-5200
Mailing Address - Street 1:1112 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1602
Mailing Address - Country:US
Mailing Address - Phone:920-388-5200
Mailing Address - Fax:
Practice Address - Street 1:1112 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1602
Practice Address - Country:US
Practice Address - Phone:920-388-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7073261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental