MEDICARE: LEAL AND SPANGLER, DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	130731	NC

General Provider Information

NPI Number	:	1275751224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAL AND SPANGLER, DDS, PA

Provider Business Mailing Address
First Line	:	1000 SOUTHPARK BLVD
Second Line	:	SUITE C
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27104-5072
Country	:	US
Telephone Number	:	336-788-5073
Fax Number	:	336-788-1699

Provider Business Practice Location Address
First Line	:	1000 SOUTHPARK BLVD
Second Line	:	SUITE C
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27104-5072
Country	:	US
Telephone Number	:	336-788-5073
Fax Number	:	336-788-1699

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RAYMOND VICTOR SPANGLER III
Credential	:	D.D.S.
Telephone Number	:	336-788-5073

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/22/2020

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