MEDICARE: DR. STEVEN WALLACE SPURRIER DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	09-438865	UT

General Provider Information

NPI Number	:	1417966581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN WALLACE SPURRIER DDS, MSD

Provider Business Mailing Address
First Line	:	3115 LION LN STE 120
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3531
Country	:	US
Telephone Number	:	801-943-7349
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 LION LN STE 120
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3531
Country	:	US
Telephone Number	:	801-943-7349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	07/08/2007

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