Provider Demographics
NPI:1710903018
Name:SPAMPATA, ROGER P (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:P
Last Name:SPAMPATA
Suffix:
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 1:2100 N BROAD ST
Mailing Address - Street 2:STE 106
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-368-8104
Mailing Address - Fax:215-368-3711
Practice Address - Street 1:2100 N BROAD ST
Practice Address - Street 2:STE 106
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-368-8104
Practice Address - Fax:215-368-3711
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027487L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12482Medicare UPIN