Provider Demographics
NPI:1376864033
Name:SPIVEY, DAVID REID (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:REID
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-2304
Mailing Address - Country:US
Mailing Address - Phone:334-864-8808
Mailing Address - Fax:334-864-8840
Practice Address - Street 1:134 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:AL
Practice Address - Zip Code:36862-2304
Practice Address - Country:US
Practice Address - Phone:334-864-8808
Practice Address - Fax:334-864-8840
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist