MEDICARE: DR. MARK ANGELO SPINAZZE DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2596	OH

General Provider Information

NPI Number	:	1417146838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANGELO SPINAZZE DDS

Provider Business Mailing Address
First Line	:	10 N RIDGE AVE
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2428
Country	:	US
Telephone Number	:	847-255-7080
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 N RIDGE AVE
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2428
Country	:	US
Telephone Number	:	847-255-7080
Fax Number	:

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	06/03/2011

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