Provider Demographics
NPI:1750326138
Name:SPONG, DAVID TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:SPONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 HORSE PEN CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8393
Mailing Address - Country:US
Mailing Address - Phone:336-274-1549
Mailing Address - Fax:336-273-4409
Practice Address - Street 1:2727 HORSE PEN CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8393
Practice Address - Country:US
Practice Address - Phone:336-274-1549
Practice Address - Fax:336-273-4409
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice