Provider Demographics
NPI:1144388992
Name:BIGHAM, TOM SPAIN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:SPAIN
Last Name:BIGHAM
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WEST COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334
Mailing Address - Country:US
Mailing Address - Phone:931-433-6169
Mailing Address - Fax:
Practice Address - Street 1:608 WEST COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334
Practice Address - Country:US
Practice Address - Phone:931-433-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS24041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice