Provider Demographics
NPI:1740330273
Name:SPANN, CHRISTA D (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:D
Last Name:SPANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SUMMERVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7401
Mailing Address - Country:US
Mailing Address - Phone:334-297-7100
Mailing Address - Fax:334-297-7065
Practice Address - Street 1:5415 SUMMERVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7401
Practice Address - Country:US
Practice Address - Phone:334-297-7100
Practice Address - Fax:334-297-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529911080Medicaid