Healthcare Provider Details

I. General information

NPI: 1942435318
Provider Name (Legal Business Name): JONATHAN DAVID SPENN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 32 AVE
OCALA FL
34471
US

IV. Provider business mailing address

1501 W SILVER SPRINGS BLVD
OCALA FL
34475
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-6868
  • Fax: 352-620-6480
Mailing address:
  • Phone: 352-622-2664
  • Fax: 352-622-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN21699
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.027785
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: