Provider Demographics
NPI:1225261100
Name:SPAHL, TERRANCE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:J
Last Name:SPAHL
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 1:1199 DULUTH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2702
Mailing Address - Country:US
Mailing Address - Phone:651-774-9000
Mailing Address - Fax:651-774-9480
Practice Address - Street 1:1199 DULUTH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2702
Practice Address - Country:US
Practice Address - Phone:651-774-9000
Practice Address - Fax:651-774-9480
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114511223G0001X
MND74751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice