MEDICARE: DR. FREDERICK L SPRADLEY D.D.S. AND M.S.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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11859	TX

General Provider Information

NPI Number	:	1538600382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK L SPRADLEY D.D.S. AND M.S.D.

Provider Business Mailing Address
First Line	:	4763 BARWICK DR
Second Line	:	SUITE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1500
Country	:	US
Telephone Number	:	817-294-5021
Fax Number	:	817-294-9310

Provider Business Practice Location Address
First Line	:	4763 BARWICK DR
Second Line	:	SUITE 107
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1500
Country	:	US
Telephone Number	:	817-294-5021
Fax Number	:	817-294-9310

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	03/13/2017

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