Provider Demographics
NPI:1992798524
Name:SPECTOR, LEONARD (DDS)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:SPECTOR
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 1:10 WARREN RD
Mailing Address - Street 2:STE 330
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2506
Mailing Address - Country:US
Mailing Address - Phone:410-666-5225
Mailing Address - Fax:410-666-7220
Practice Address - Street 1:10 WARREN RD
Practice Address - Street 2:STE 330
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2506
Practice Address - Country:US
Practice Address - Phone:410-666-5225
Practice Address - Fax:410-666-7220
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8759204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T59459Medicare UPIN
MD125L920AMedicare ID - Type Unspecified