Healthcare Provider Details

I. General information

NPI: 1710903018
Provider Name (Legal Business Name): ROGER P SPAMPATA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N BROAD ST STE 106
LANSDALE PA
19446
US

IV. Provider business mailing address

2100 N BROAD ST STE 106
LANSDALE PA
19446
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-8104
  • Fax: 215-368-3711
Mailing address:
  • Phone: 215-368-8104
  • Fax: 215-368-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS027487L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: