Healthcare Provider Details

I. General information

NPI: 1740282656
Provider Name (Legal Business Name): WILLIAM GRANGER SPANGLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE
WASHINGTON DC
20338-0001
US

IV. Provider business mailing address

3460B S UTAH ST
ARLINGTON VA
22206-1921
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-5519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS020162L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: