Provider Demographics
NPI:1932242096
Name:SPIRA, ERNEST B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:B
Last Name:SPIRA
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 1:1420 MAIN ST
Mailing Address - Street 2:SUITE 134
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3110
Mailing Address - Country:US
Mailing Address - Phone:860-659-0307
Mailing Address - Fax:860-633-2048
Practice Address - Street 1:1420 MAIN ST
Practice Address - Street 2:SUITE 134
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3110
Practice Address - Country:US
Practice Address - Phone:860-659-0307
Practice Address - Fax:860-633-2048
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics