Provider Demographics
NPI:1306037569
Name:SPURLOCK, CHARLES CALEB (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CALEB
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 1:1203 WEST DOGWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4756
Mailing Address - Country:US
Mailing Address - Phone:409-283-3721
Mailing Address - Fax:409-283-5448
Practice Address - Street 1:1203 WEST DOGWOOD STREET
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4756
Practice Address - Country:US
Practice Address - Phone:409-283-3721
Practice Address - Fax:409-283-5448
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 23366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist