Provider Demographics
NPI:1215131669
Name:SPIELBERGER, MICHAEL CLARK (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARK
Last Name:SPIELBERGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHERATON LN S
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7727
Mailing Address - Country:US
Mailing Address - Phone:518-793-6595
Mailing Address - Fax:
Practice Address - Street 1:21 PINE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3410
Practice Address - Country:US
Practice Address - Phone:518-792-3256
Practice Address - Fax:518-792-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice