Individual
WAYNE JULIAN SPECTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
680 2ND AVE. NORTH, KETCHUM, ID 83340
(208) 726-7559
Mailing address
PO BOX 4591, KETCHUM, ID 83340-4591
(208) 726-7559
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1762
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS4867
ID STATE BOARD OF PHARMAC
ID
01
—
D-1762
ID STATE BOARD OF DENTIST
ID
Enumeration date
05/18/2007
Last updated
07/08/2007
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