Provider Demographics
NPI:1932581360
Name:ELIZABETH B SPATARO DMD
Entity Type:Organization
Organization Name:ELIZABETH B SPATARO DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SPATARO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-721-1660
Mailing Address - Street 1:950 FRANCIS PL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2465
Mailing Address - Country:US
Mailing Address - Phone:314-721-1660
Mailing Address - Fax:314-725-4643
Practice Address - Street 1:950 FRANCIS PL
Practice Address - Street 2:SUITE 206
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2465
Practice Address - Country:US
Practice Address - Phone:314-721-1660
Practice Address - Fax:314-725-4643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZABETH B SPATARO DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-22
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty