Provider Demographics
NPI:1497924542
Name:SPAIN, JOHN HOWELL (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HOWELL
Last Name:SPAIN
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 1:1301 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3642
Mailing Address - Country:US
Mailing Address - Phone:606-324-4717
Mailing Address - Fax:606-329-2119
Practice Address - Street 1:1301 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3642
Practice Address - Country:US
Practice Address - Phone:606-324-4717
Practice Address - Fax:606-329-2119
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist