Provider Demographics
NPI:1477032084
Name:DR ROBERT SPATAFORA DDS
Entity type:Organization
Organization Name:DR ROBERT SPATAFORA DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPATAFORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-325-5764
Mailing Address - Street 1:2212 JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3620
Mailing Address - Country:US
Mailing Address - Phone:318-325-5764
Mailing Address - Fax:318-325-7940
Practice Address - Street 1:2212 JUSTICE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3620
Practice Address - Country:US
Practice Address - Phone:318-325-5764
Practice Address - Fax:318-325-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3206332B00000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA29653Medicaid