Healthcare Provider Details

I. General information

NPI: 1326137597
Provider Name (Legal Business Name): CLARA M. SPATAFORE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLARA M. SPATAFORE D.D.S., MS

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2593 WEXFORD BAYNE RD STE 304
SEWICKLEY PA
15143-8608
US

IV. Provider business mailing address

2593 WEXFORD BAYNE RD STE 304
SEWICKLEY PA
15143-8608
US

V. Phone/Fax

Practice location:
  • Phone: 724-940-3963
  • Fax: 724-940-3965
Mailing address:
  • Phone: 724-940-3963
  • Fax: 724-940-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS023991L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: