Healthcare Provider Details

I. General information

NPI: 1578623542
Provider Name (Legal Business Name): ANTHONY H SPANN, DDS & ASSOCIATES(POLARIS), INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 LANDERBROOK DR STE 250
MAYFIELD HEIGHTS OH
44124-6502
US

IV. Provider business mailing address

1400 POLARIS PKWY
COLUMBUS OH
43240-2040
US

V. Phone/Fax

Practice location:
  • Phone: 800-487-4867
  • Fax: 216-593-7533
Mailing address:
  • Phone: 614-985-3338
  • Fax: 614-985-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY B REICHERT
Title or Position: CREDENTIALING DEPARTMENT LEAD
Credential:
Phone: 800-487-4867