Healthcare Provider Details

I. General information

NPI: 1386740686
Provider Name (Legal Business Name): THOMAS MATTHEWS SPIVEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E SHORT MOUNTAIN ST
PARIS AR
72855-3338
US

IV. Provider business mailing address

PO BOX 387
PARIS AR
72855-0387
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-2292
  • Fax: 479-963-3501
Mailing address:
  • Phone: 479-963-2292
  • Fax: 479-963-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2335
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: