Provider Demographics
NPI:1225356124
Name:SPURLOCK, NOEL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:L
Last Name:SPURLOCK
Suffix:
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 1:4041 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1917
Mailing Address - Country:US
Mailing Address - Phone:850-994-8185
Mailing Address - Fax:
Practice Address - Street 1:4041 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1917
Practice Address - Country:US
Practice Address - Phone:850-994-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist