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General NPI Number Information
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NPI Number | 1619933603
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Entity Type | Organization
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Legal Business Name | SPURGEON DENTAL PC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 222 S SUMMIT AVE #2
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City | PRESCOTT
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State | AZ
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Zip | 86303
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Country | US
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Telephone | 928-445-2440
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Fax | 928-778-4240
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Provider Business Mailing Address
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Address Line | 222 S SUMMIT AVE #2
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City | PRESCOTT
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State | AZ
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Zip | 86303
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Country | US
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Telephone | 928-445-2440
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Fax | 928-778-4240
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. JAMES C SPURGEON
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Credential | DDS
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Telephone | 928-445-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | AZ5571
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License Number State | AZ
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