Provider Demographics
NPI:1164557922
Name:SPANG, WILLIAM CLEMENS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLEMENS
Last Name:SPANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PEGGY DR
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-1001
Mailing Address - Country:US
Mailing Address - Phone:508-865-2504
Mailing Address - Fax:
Practice Address - Street 1:101 ELM ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2601
Practice Address - Country:US
Practice Address - Phone:508-865-6265
Practice Address - Fax:508-865-6265
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice