Provider Demographics
NPI:1619185873
Name:SPADAFORA, SANDRA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:SPADAFORA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5299 PARK BLVD.
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3418
Mailing Address - Country:US
Mailing Address - Phone:727-547-8227
Mailing Address - Fax:727-547-5252
Practice Address - Street 1:5299 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3418
Practice Address - Country:US
Practice Address - Phone:727-547-8227
Practice Address - Fax:727-547-5252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00125561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice