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NPI Code Detail

MEDICARE: CHARLES SPICER D.M.D.

MEDICARE: CHARLES SPICER D.M.D.
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
1122300000XDentistDN015012GA

General Provider Information

NPI Number : 1457733289
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES SPICER D.M.D.
Provider Business Mailing Address
First Line : 1011 PARKSIDE MAIN
Second Line :
City : GREENSBORO
State : GA
Zip : 30642-4543
Country : US
Telephone Number : 706-453-1333
Fax Number :
Provider Business Practice Location Address
First Line : 1011 PARKSIDE MAIN
Second Line :
City : GREENSBORO
State : GA
Zip : 30642-4543
Country : US
Telephone Number : 706-453-1333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2015
Last Update Date : 01/23/2017

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