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General NPI Number Information
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NPI Number | 1578936514
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Entity Type | Organization
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Legal Business Name | SPADAFORE ORTHODONTICS, INC.
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 111 PARK VIEW LN
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City | WHEELING
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State | WV
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Zip | 26003-5493
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Country | US
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Telephone | 304-233-1180
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Fax | 304-233-1196
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Provider Business Mailing Address
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Address Line | 111 PARK VIEW LN
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City | WHEELING
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State | WV
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Zip | 26003-5493
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Country | US
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Telephone | 304-233-1180
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Fax | 304-233-1196
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES A SPADAFORE
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Credential | DDS, MSD
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Telephone | 304-233-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3035
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License Number State | WV
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