Provider Demographics
NPI:1295090348
Name:SPADOLA, LAINE ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAINE
Middle Name:ANNE
Last Name:SPADOLA
Suffix:
Gender:F
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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742
Mailing Address - Country:US
Mailing Address - Phone:845-707-8400
Mailing Address - Fax:845-707-8916
Practice Address - Street 1:606 OLD ROUTE 17
Practice Address - Street 2:DISCOVERY HEALTH CENTER
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-707-8400
Practice Address - Fax:845-707-8916
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56702-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice