Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401412453 | VA |
N | 1223P0221X | Pediatric Dentist | 0401412453 | VA |
NPI | 1710114822 |
---|---|
Provider Name | Marina Spektor |
First Address | Richmond, VA 23220-3521 |
Second Address | Richmond, VA 23220-3521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 16/06/2009 |