Provider Demographics
NPI:1225102668
Name:SPADAFORA, DALE F (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:F
Last Name:SPADAFORA
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 1:752 BROOKSHIRE DR.
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148
Mailing Address - Country:US
Mailing Address - Phone:724-342-7395
Mailing Address - Fax:724-342-6819
Practice Address - Street 1:752 BROOKSHIRE DR
Practice Address - Street 2:SUITE 'A'
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4510
Practice Address - Country:US
Practice Address - Phone:724-342-7395
Practice Address - Fax:724-342-6819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027769-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist