Healthcare Provider Details

I. General information

NPI: 1093833303
Provider Name (Legal Business Name): JOSEPH ANTHONY SPOLIDORO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 PALOS VERDES DR N STE 210
ROLLING HILLS ESTATES CA
90274-2534
US

IV. Provider business mailing address

22920 NADINE CIR UNIT B
TORRANCE CA
90505-8873
US

V. Phone/Fax

Practice location:
  • Phone: 310-930-4635
  • Fax:
Mailing address:
  • Phone: 310-930-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD21952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: