Provider Demographics
NPI:1033605597
Name:BIERLEIN, SPENCER R
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:R
Last Name:BIERLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4908
Mailing Address - Country:US
Mailing Address - Phone:989-598-7268
Mailing Address - Fax:
Practice Address - Street 1:2405 CRESTMOOR RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2005
Practice Address - Country:US
Practice Address - Phone:615-258-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010226991223G0001X
TN108641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice