Provider Demographics
NPI:1316136047
Name:SPIEGEL, JAY HAROLD (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:HAROLD
Last Name:SPIEGEL
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 1:4235 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5343
Mailing Address - Country:US
Mailing Address - Phone:602-843-2518
Mailing Address - Fax:602-843-2303
Practice Address - Street 1:4235 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5343
Practice Address - Country:US
Practice Address - Phone:602-843-2518
Practice Address - Fax:602-843-2303
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice