Provider Demographics
NPI:1316242779
Name:SPELLMAN, ERIC H (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
Last Name:SPELLMAN
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 1:16 N CHATSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2143
Mailing Address - Country:US
Mailing Address - Phone:914-834-2941
Mailing Address - Fax:914-834-2458
Practice Address - Street 1:16 N CHATSWORTH AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2143
Practice Address - Country:US
Practice Address - Phone:914-834-2941
Practice Address - Fax:914-834-2458
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice