=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114097268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN SCOTT SPRAYBERRY D.M.D., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 773 N DEAN RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36830-4027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-821-5031
-----------------------------------------------------
Fax | 334-821-7037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 773 N DEAN RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36830-4027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-821-5031
-----------------------------------------------------
Fax | 334-821-7037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 4816
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------