Healthcare Provider Details

I. General information

NPI: 1477032084
Provider Name (Legal Business Name): DR ROBERT SPATAFORA DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 JUSTICE ST
MONROE LA
71201-3620
US

IV. Provider business mailing address

2212 JUSTICE ST
MONROE LA
71201-3620
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-5764
  • Fax: 318-325-7940
Mailing address:
  • Phone: 318-325-5764
  • Fax: 318-325-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3206
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT E SPATAFORA
Title or Position: DENTIST
Credential: DDS
Phone: 318-325-5764