Healthcare Provider Details

I. General information

NPI: 1417107632
Provider Name (Legal Business Name): THOMAS M. SPIVEY, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EAST SHORT MOUNTAIN STREET
PARIS AR
72855
US

IV. Provider business mailing address

20 EAST SHORT MOUNTAIN STREET
PARIS AR
72855
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-2292
  • Fax:
Mailing address:
  • Phone: 479-963-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2335
License Number StateAR

VIII. Authorized Official

Name: DR. THOMAS M SPIVEY
Title or Position: DENTIST
Credential: D.D.S.,P.A.
Phone: 479-963-2292