Healthcare Provider Details

I. General information

NPI: 1518983105
Provider Name (Legal Business Name): GRETA TINGLE SPURLOCK R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1310 24TH AVE S 160
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

6229 ROCKY TOP DR
ANTIOCH TN
37013-5656
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-5321
  • Fax: 615-321-6339
Mailing address:
  • Phone: 615-306-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number00768
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: