Healthcare Provider Details

I. General information

NPI: 1457888174
Provider Name (Legal Business Name): AQUILLA SPREWELL D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HIGHWAY 46 S
DICKSON TN
37055-2545
US

IV. Provider business mailing address

4379 REESEWOOD CT
COLUMBUS GA
31907-2765
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-1436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10699
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: