Provider Demographics
NPI:1316257694
Name:SPAHR, JEFFERY DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DAVID
Last Name:SPAHR
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:PO BOX B
Mailing Address - Street 2:112 SOUTH B STREET
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405-9332
Mailing Address - Country:US
Mailing Address - Phone:402-761-2351
Mailing Address - Fax:402-761-2352
Practice Address - Street 1:112 SOUTH B STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405-9332
Practice Address - Country:US
Practice Address - Phone:402-761-2351
Practice Address - Fax:402-761-2352
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025610500Medicaid