Provider Demographics
NPI:1457345217
Name:SPINAZZE, DENNIS J (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:SPINAZZE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2428
Mailing Address - Country:US
Mailing Address - Phone:847-255-7080
Mailing Address - Fax:847-255-6931
Practice Address - Street 1:10 N RIDGE AVE
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2428
Practice Address - Country:US
Practice Address - Phone:847-255-7080
Practice Address - Fax:847-255-6931
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97491Medicare ID - Type Unspecified
L59392Medicare ID - Type Unspecified
T37030Medicare UPIN
P15808Medicare ID - Type Unspecified
ILL59395Medicare ID - Type Unspecified
ILL98833Medicare ID - Type Unspecified