Provider Demographics
NPI:1902936461
Name:DR TERRANCE J SPAHL
Entity Type:Organization
Organization Name:DR TERRANCE J SPAHL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-774-9000
Mailing Address - Street 1:1199 DULUTH ST
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106
Mailing Address - Country:US
Mailing Address - Phone:651-774-9000
Mailing Address - Fax:651-774-9480
Practice Address - Street 1:1199 DULUTH ST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-774-9000
Practice Address - Fax:651-774-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty