Provider Demographics
NPI:1417107632
Name:THOMAS M. SPIVEY, D.D.S., P.A.
Entity Type:Organization
Organization Name:THOMAS M. SPIVEY, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:479-963-2292
Mailing Address - Street 1:20 EAST SHORT MOUNTAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855
Mailing Address - Country:US
Mailing Address - Phone:479-963-2292
Mailing Address - Fax:
Practice Address - Street 1:20 EAST SHORT MOUNTAIN STREET
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855
Practice Address - Country:US
Practice Address - Phone:479-963-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58946OtherBLUE CROSS BLUE SHIELD