Provider Demographics
NPI:1679547350
Name:SPAGNOLI, DANIEL B (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:SPAGNOLI
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621-B NORTH FODALE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:910-269-2420
Mailing Address - Fax:910-269-2410
Practice Address - Street 1:90 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28461-3350
Practice Address - Country:US
Practice Address - Phone:910-269-2420
Practice Address - Fax:910-269-2410
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63401223S0112X
NC59931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC98018OtherBCBS
SCZN5993Medicaid
LA1863408Medicaid
NC8998018Medicaid
NC98018OtherBCBS
NC8998018Medicaid
LA283354YH3TMedicare PIN