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General NPI Number Information
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NPI Number | 1295280444
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Entity Type | Organization
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Legal Business Name | JAN L. SPAGNOLI DDS PA
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 55 N CARPENTER RD
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City | TITUSVILLE
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State | FL
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Zip | 32796-2204
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Country | US
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Telephone | 321-269-3802
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Fax |
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Provider Business Mailing Address
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Address Line | 55 N CARPENTER RD
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City | TITUSVILLE
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State | FL
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Zip | 32796-2204
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Country | US
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Telephone | 321-269-3802
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAN L. SPAGNOLI
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Credential | DDS
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Telephone | 321-269-3802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN10166
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License Number State | FL
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