Provider Demographics
NPI:1417146838
Name:SPINAZZE, MARK ANGELO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANGELO
Last Name:SPINAZZE
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 1:10 N RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2428
Mailing Address - Country:US
Mailing Address - Phone:847-255-7080
Mailing Address - Fax:
Practice Address - Street 1:10 N RIDGE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2428
Practice Address - Country:US
Practice Address - Phone:847-255-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery