Provider Demographics
NPI:1477918571
Name:SPAIN, DENNIS EARL JR (CPT, LSN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EARL
Last Name:SPAIN
Suffix:JR
Gender:M
Credentials:CPT, LSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N SAINT PAUL ST
Mailing Address - Street 2:#310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3114
Mailing Address - Country:US
Mailing Address - Phone:214-205-8915
Mailing Address - Fax:469-904-2740
Practice Address - Street 1:400 N SAINT PAUL ST
Practice Address - Street 2:#310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3114
Practice Address - Country:US
Practice Address - Phone:214-205-8915
Practice Address - Fax:469-904-2740
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2728294133NN1002X
TX27282932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education