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General NPI Number Information
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NPI Number | 1760961817
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Entity Type | Organization
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Legal Business Name | SPIKA DENTAL, INC.
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 312 W LINE ST
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City | BISHOP
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State | CA
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Zip | 93514-3413
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Country | US
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Telephone | 253-651-0705
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2185
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City | MAMMOTH LAKES
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State | CA
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Zip | 93546-2185
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADFORD CHARLES SPIKA
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Credential | DMD
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Telephone | 253-651-0705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 102998
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License Number State | CA
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