Provider Demographics
NPI:1306806716
Name:SPANEL, KENNETH A (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:SPANEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 REGENCY PARKWAY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3787
Mailing Address - Country:US
Mailing Address - Phone:402-399-0900
Mailing Address - Fax:402-399-1629
Practice Address - Street 1:260 REGENCY PARKWAY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3787
Practice Address - Country:US
Practice Address - Phone:402-399-0900
Practice Address - Fax:402-399-1629
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE49691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice