Provider Demographics
NPI:1962521229
Name:CHRISTA D. SPANN DMD, LLC
Entity type:Organization
Organization Name:CHRISTA D. SPANN DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-297-7100
Mailing Address - Street 1:5415 SUMMERVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7401
Mailing Address - Country:US
Mailing Address - Phone:334-297-7100
Mailing Address - Fax:334-297-7065
Practice Address - Street 1:5415 SUMMERVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7401
Practice Address - Country:US
Practice Address - Phone:334-297-7100
Practice Address - Fax:334-297-7065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTA D. SPANN DMD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========Medicaid