MEDICARE: DR. STEVEN BLAKE SPOTO 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	1223G0001X	General Practice Dentistry	DN24861	FL
2	122300000X	Dentist	DN24861	FL

General Provider Information

NPI Number	:	1982213567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN BLAKE SPOTO DMD

Provider Business Mailing Address
First Line	:	6837 NORMANDY DR BLDG B
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8226 STONER HILLS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5222
Country	:	US
Telephone Number	:	813-482-6424
Fax Number	:

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

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	03/10/2023

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