Provider Demographics
NPI:1215248323
Name:SPANN, CARLA JUNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:JUNE
Last Name:SPANN
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 1:1208 E BETHANY DR
Mailing Address - Street 2:7
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3659
Mailing Address - Country:US
Mailing Address - Phone:972-390-8500
Mailing Address - Fax:972-390-8504
Practice Address - Street 1:1208 E BETHANY DR
Practice Address - Street 2:7
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3659
Practice Address - Country:US
Practice Address - Phone:972-390-8500
Practice Address - Fax:972-390-8504
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255601223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice