Provider Demographics
NPI:1255427118
Name:SPANDAU, CAROLYNN EH (DDS)
Entity type:Individual
Prefix:MRS
First Name:CAROLYNN
Middle Name:EH
Last Name:SPANDAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 BANTA RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-6000
Mailing Address - Country:US
Mailing Address - Phone:317-422-5136
Mailing Address - Fax:317-271-2783
Practice Address - Street 1:1030 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1813
Practice Address - Country:US
Practice Address - Phone:317-271-1488
Practice Address - Fax:317-271-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN82671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice