Provider Demographics
NPI:1578936514
Name:SPADAFORE ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:SPADAFORE ORTHODONTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPADAFORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:304-233-1180
Mailing Address - Street 1:111 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5493
Mailing Address - Country:US
Mailing Address - Phone:304-233-1180
Mailing Address - Fax:304-233-1196
Practice Address - Street 1:111 PARK VIEW LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5493
Practice Address - Country:US
Practice Address - Phone:304-233-1180
Practice Address - Fax:304-233-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty