Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | MO14210 | MO |
NPI | 1013004480 |
---|---|
Provider Name | Dr. Elizabeth B Spataro |
First Address | Saint Louis, MO 63105 |
Second Address | Saint Louis, MO 63105-2465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 26/06/2015 |