Provider Demographics
NPI:1952650731
Name:SPADAFORA, MICHAEL T (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:SPADAFORA
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 1:17 GABLEWING CIR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3316
Mailing Address - Country:US
Mailing Address - Phone:267-566-3081
Mailing Address - Fax:
Practice Address - Street 1:95 ALMSHOUSE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1154
Practice Address - Country:US
Practice Address - Phone:215-364-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22 DI 02511200122300000X
PADS 039154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist