Provider Demographics
NPI:1023044922
Name:SPATZ, SHERMAN (DMD)
Entity type:Individual
Prefix:
First Name:SHERMAN
Middle Name:
Last Name:SPATZ
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 1:90 WEST CHESTNUT ST
Mailing Address - Street 2:SUITE 125LL
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-222-3422
Mailing Address - Fax:724-222-8391
Practice Address - Street 1:90 WEST CHESTNUT ST
Practice Address - Street 2:SUITE 125LL
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-222-3422
Practice Address - Fax:724-222-8391
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014362L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005215630006Medicaid
T71633Medicare UPIN