Provider Demographics
NPI:1528181849
Name:SPOTO, JOSEPH CLYDE III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CLYDE
Last Name:SPOTO
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 APOLLO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2262
Mailing Address - Country:US
Mailing Address - Phone:813-641-1855
Mailing Address - Fax:
Practice Address - Street 1:224 APOLLO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2262
Practice Address - Country:US
Practice Address - Phone:813-641-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0117061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice