Provider Demographics
NPI:1730243882
Name:SPAGNOLA, JOHN R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SPAGNOLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1201
Mailing Address - Country:US
Mailing Address - Phone:856-424-3010
Mailing Address - Fax:856-424-5744
Practice Address - Street 1:2001 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1201
Practice Address - Country:US
Practice Address - Phone:856-424-3010
Practice Address - Fax:856-424-5744
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1009556001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice