Provider Demographics
NPI:1184769945
Name:SPADOLA, CARL J (DMD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:J
Last Name:SPADOLA
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 1:415 HIGHLAND AVE
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 AVE
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist