Provider Demographics
NPI:1235368515
Name:SPANO, DANA MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MICHELLE
Last Name:SPANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2005
Mailing Address - Country:US
Mailing Address - Phone:609-365-2424
Mailing Address - Fax:609-365-2671
Practice Address - Street 1:314 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2005
Practice Address - Country:US
Practice Address - Phone:609-365-2424
Practice Address - Fax:609-365-2671
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ241341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice