Healthcare Provider Details

I. General information

NPI: 1548218977
Provider Name (Legal Business Name): GEORGE JOOSEPH SPADER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7437 JACKMAN RD
TEMPERANCE MI
48182-9223
US

IV. Provider business mailing address

7437 JACKMAN RD
TEMPERANCE MI
48182-9223
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-1780
  • Fax: 734-847-2080
Mailing address:
  • Phone: 734-847-1780
  • Fax: 734-847-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: