# LON PATRICK SPAIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1891765822
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3400 | WV | Yes |

## Other

- **Enumeration date:** 01/24/2006
- **Last updated:** 09/17/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2036862 | — | OH |
| 05 | — | 7100174300 | — | KY |
| 05 | — | 7805006000 | — | WV |