Provider Demographics
NPI:1710107107
Name:SPAETH, PAUL VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VINCENT
Last Name:SPAETH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:VINCENT
Other - Last Name:SPAETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1288 W ORANGE GROVE RD.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-575-8800
Mailing Address - Fax:520-742-4120
Practice Address - Street 1:1288 W ORANGE GROVE RD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-575-8800
Practice Address - Fax:520-742-4120
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice