Provider Demographics
NPI:1003938333
Name:FRED L. SPRADLEY, D.D.S., M.S.D., P.A.
Entity Type:Organization
Organization Name:FRED L. SPRADLEY, D.D.S., M.S.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS AND MSD
Authorized Official - Phone:817-294-5021
Mailing Address - Street 1:4763 BARWICK DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1500
Mailing Address - Country:US
Mailing Address - Phone:817-294-5021
Mailing Address - Fax:817-294-9310
Practice Address - Street 1:4763 BARWICK DR
Practice Address - Street 2:SUITE 107
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1500
Practice Address - Country:US
Practice Address - Phone:817-294-5021
Practice Address - Fax:817-294-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty