Provider Demographics
NPI:1972511772
Name:SPADOLA & VINCENT, DMD, LLC
Entity Type:Organization
Organization Name:SPADOLA & VINCENT, DMD, LLC
Other - Org Name:SPADOLA & VINCENT DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPADOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-272-9694
Mailing Address - Street 1:415 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410
Mailing Address - Country:US
Mailing Address - Phone:203-272-9694
Mailing Address - Fax:203-272-1927
Practice Address - Street 1:415 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:203-272-9694
Practice Address - Fax:203-272-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6052122300000X
CT9505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty