Healthcare Provider Details

I. General information

NPI: 1346209103
Provider Name (Legal Business Name): CHARLES BRIAN SPRIGGS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 N 32ND ST SUITE 108
PHOENIX AZ
85018-3300
US

IV. Provider business mailing address

4715 N 32ND ST SUITE 108
PHOENIX AZ
85018-3300
US

V. Phone/Fax

Practice location:
  • Phone: 602-667-6673
  • Fax: 888-523-9006
Mailing address:
  • Phone: 602-667-6673
  • Fax: 888-523-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8004
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: