MEDICARE: DR. CRAIG CARLTON SPANGLER D.D.S.

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	12158	MI
2	1223G0001X	General Practice Dentistry	2901012158	MI

General Provider Information

NPI Number	:	1336244995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG CARLTON SPANGLER D.D.S.

Provider Business Mailing Address
First Line	:	3953 COTTONTAIL LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-1909
Country	:	US
Telephone Number	:	248-561-3507
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MAPLE RD
Second Line	:	SUITE 220
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3148
Country	:	US
Telephone Number	:	248-645-9831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/18/2022

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