Provider Demographics
NPI:1053663856
Name:CARLA J SPANN DDS PLLC
Entity Type:Organization
Organization Name:CARLA J SPANN DDS PLLC
Other - Org Name:BETHANY HEIGHTS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-390-8500
Mailing Address - Street 1:1208 E BETHANY DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3659
Mailing Address - Country:US
Mailing Address - Phone:972-390-8500
Mailing Address - Fax:
Practice Address - Street 1:1208 E BETHANY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3659
Practice Address - Country:US
Practice Address - Phone:972-390-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty