Provider Demographics
NPI:1437291077
Name:MCSPADDEN, HAROLD DEAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DEAN
Last Name:MCSPADDEN
Suffix:JR
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:ELM AND CARLTON ST
Mailing Address - Street 2:DEPT. OF DENTISTRY AND MAXILLOFACIAL PROSTHETICS
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:800-767-9355
Mailing Address - Fax:
Practice Address - Street 1:ELM & CARLTON STREETS
Practice Address - Street 2:DEPT. OF DENTISTRY AND MAX. PROSTHETICS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:800-767-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10000898122300000X
NY041358-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000906808Medicaid