MEDICARE: DR. DALE F SPADAFORA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS-027769-L	PA

General Provider Information

NPI Number	:	1225102668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE F SPADAFORA DMD

Provider Business Mailing Address
First Line	:	752 BROOKSHIRE DR.
Second Line	:	SUITE 'A'
City	:	HERMITAGE
State	:	PA
Zip	:	16148
Country	:	US
Telephone Number	:	724-342-7395
Fax Number	:	724-342-6819

Provider Business Practice Location Address
First Line	:	752 BROOKSHIRE DR
Second Line	:	SUITE 'A'
City	:	HERMITAGE
State	:	PA
Zip	:	16148-4510
Country	:	US
Telephone Number	:	724-342-7395
Fax Number	:	724-342-6819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2006
Last Update Date	:	07/08/2007

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