Provider Demographics
NPI:1215024997
Name:SPRUIELL, GLORIA JOHNSON (DMD)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JOHNSON
Last Name:SPRUIELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15410 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1576
Mailing Address - Country:US
Mailing Address - Phone:757-886-9169
Mailing Address - Fax:757-847-8894
Practice Address - Street 1:15410 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-1576
Practice Address - Country:US
Practice Address - Phone:757-886-9169
Practice Address - Fax:757-847-8894
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010073891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA725238OtherUNITED CONCORDIA