Provider Demographics
NPI:1821361098
Name:KENNETH A SPANEL DDS PC
Entity Type:Organization
Organization Name:KENNETH A SPANEL DDS PC
Other - Org Name:REGENCY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SPANEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-399-0900
Mailing Address - Street 1:260 REGENCY PARKWAY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3787
Mailing Address - Country:US
Mailing Address - Phone:402-399-0900
Mailing Address - Fax:402-399-1629
Practice Address - Street 1:260 REGENCY PARKWAY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3787
Practice Address - Country:US
Practice Address - Phone:402-399-0900
Practice Address - Fax:402-399-1629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNETH A SPANEL DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty