Provider Demographics
NPI:1275751224
Name:LEAL AND SPANGLER, DDS, PA
Entity Type:Organization
Organization Name:LEAL AND SPANGLER, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-788-5073
Mailing Address - Street 1:1000 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5072
Mailing Address - Country:US
Mailing Address - Phone:336-788-5073
Mailing Address - Fax:336-788-1699
Practice Address - Street 1:1000 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-5072
Practice Address - Country:US
Practice Address - Phone:336-788-5073
Practice Address - Fax:336-788-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1307311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty