MEDICARE: DR. BRYAN RANDALL SPURRIER D.D.S.

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	8494	NC
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401410613	VA

General Provider Information

NPI Number	:	1619102696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN RANDALL SPURRIER D.D.S.

Provider Business Mailing Address
First Line	:	2153 ASTORIA CIR APT 109
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-4057
Country	:	US
Telephone Number	:	703-774-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 PINEY FOREST RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-2812
Country	:	US
Telephone Number	:	434-792-0141
Fax Number	:

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	06/09/2009

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