Provider Demographics
NPI:1215144480
Name:SPANGLER, GENA T (DDS)
Entity type:Individual
Prefix:DR
First Name:GENA
Middle Name:T
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 THOMAS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-6016
Mailing Address - Country:US
Mailing Address - Phone:318-648-7200
Mailing Address - Fax:318-648-1999
Practice Address - Street 1:480 THOMAS MILL RD
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-6016
Practice Address - Country:US
Practice Address - Phone:318-648-7200
Practice Address - Fax:318-648-1999
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice