Provider Demographics
NPI:1649292509
Name:SPAGNUOLO, CHRISTINA ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:SPAGNUOLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:SPAGNUOLO
Other - Last Name:CONDION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1048 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-323-0449
Mailing Address - Fax:617-323-8913
Practice Address - Street 1:1048 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-323-0449
Practice Address - Fax:617-323-8913
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist